Spinal correction system and method

ABSTRACT

A method includes providing first and second instruments. First and second fasteners are attached with vertebrae. First fasteners are connected with first and second constructs. Second fasteners are connected with a third and fourth constructs. The first construct is connected with a body of the first instrument and the second construct is connected with another body of the first instrument. The third construct is connected with a body of the second instrument and the fourth construct is connected with another body of the second instrument. Joints of the instruments are tightened. At least one of the instruments is selectively distracted. At least one of the instruments is selectively compressed. The spinal constructs are removed from the fasteners. The first fasteners are connected with a first spinal rod. The second fasteners are connected with a second spinal rod. In some embodiments, spinal constructs, implants, systems and kits are disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.15/940,231, filed Mar. 29, 2018, which is a continuation-in-part of U.S.patent application Ser. No. 15/139,406, filed Apr. 27, 2016, now U.S.Pat. No. 10,194,958. These applications are expressly incorporatedherein by reference, in their entireties.

TECHNICAL FIELD

The present disclosure generally relates to medical devices for thetreatment of spinal disorders, and more particularly to a surgicalsystem and a method for correction of a spinal disorder.

BACKGROUND

Spinal disorders such as degenerative disc disease, disc herniation,osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvatureabnormalities, kyphosis, tumor, and fracture may result from factorsincluding trauma, disease and degenerative conditions caused by injuryand aging. Spinal disorders typically result in symptoms including pain,nerve damage, and partial or complete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercisecan be effective, however, may fail to relieve the symptoms associatedwith these disorders. Surgical treatment of these spinal disordersincludes correction, corpectomy, discectomy, laminectomy, fusion,fixation and implantable prosthetics. Correction treatments used forpositioning and alignment of vertebrae may employ implants, such as, forexample, spinal constructs and interbody devices, for stabilization of atreated section of a spine. In some cases, the spinal constructs may bemanipulated with surgical instruments for compression and distraction ofvertebrae. This disclosure describes an improvement over these priortechnologies.

SUMMARY

In one embodiment, a method for treating a spine is provided. The methodcomprises the steps of: providing a first surgical instrument and asecond surgical instrument, the surgical instruments each including afirst arm and a second arm, the arms each having a first part and a bodythat is movably connected to the first part at a first joint; attachingfirst fasteners with vertebrae; attaching second fasteners with thevertebrae; connecting two of the first fasteners with a first spinalconstruct and two of the first fasteners with a second spinal construct;connecting two of the second fasteners with a third spinal construct andtwo of the second fasteners with a fourth spinal construct; connectingthe first spinal construct with one of the bodies of the first surgicalinstrument and connecting the second spinal construct with the other oneof the bodies of the first surgical instrument; connecting the thirdspinal construct with one of the bodies of the second surgicalinstrument and connecting the fourth spinal construct with the other oneof the bodies of the second surgical instrument; tightening the firstjoints to lock the bodies relative to the first parts; selectivelydistracting at least one of the surgical instruments; selectivelycompressing at least one of the surgical instruments; removing thespinal constructs from the fasteners; connecting the first fastenerswith a first spinal rod; and connecting the second fasteners with asecond spinal rod.

In one embodiment, a method for treating a spine is provided. The methodcomprises the steps of: providing a first surgical instrument and asecond surgical instrument, the surgical instruments each including afirst arm and a second arm, the arms each having a first part that ismovably connected to a sleeve at a first joint; attaching firstfasteners with vertebrae; attaching second fasteners with the vertebrae;connecting the sleeves of the first surgical instrument with the firstfasteners such that the sleeves of the first surgical instrumentdirectly engage the first fasteners; connecting the sleeves of thesecond spinal construct with the second fasteners such that the sleevesof the second surgical instrument directly engage the second fasteners;tightening the first joints to lock a respective one of the first partsrelative to a respective one of the second parts; selectivelydistracting at least one of the surgical instruments; selectivelycompressing at least one of the surgical instruments; removing thesleeves from the fasteners; connecting the first fasteners with a firstspinal rod; and connecting the second fasteners with a second spinalrod.

In one embodiment, kit for treating a spine is provided. The kitcomprises a first controller, a second controller, a plurality of bonefasteners, a plurality of temporary spinal rods and a plurality ofpermanent spinal rods. The controllers each include: a longitudinalelement; a first arm connected with the longitudinal element andincluding a body engageable with a first spinal construct, the bodybeing rotatable relative to the first arm in a first orientation and asecond orientation, the body including a lock to fix the body relativeto the first arm; and a second arm being axially translatable relativeto the first arm and including a body engageable with a second spinalconstruct, the body of the second arm being rotatable relative to thesecond arm in a first orientation and a second orientation, the body ofthe second arm including a lock to fix the body of the second armrelative to the second arm. In some embodiments, the kit does notinclude temporary spinal rods or permanent spinal rods. In someembodiments, the kit includes an adjacent set that goes with acontroller set, the adjacent set being separate from the controller set.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure will become more readily apparent from thespecific description accompanied by the following drawings, in which:

FIG. 1 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 2 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 3 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 4 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 5 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 6 is a cutaway view of components of the system shown in FIG. 5 ;

FIG. 7 is a perspective view in part cross section of the componentsshown in FIG. 6 ;

FIG. 8 is a break away perspective view of the components shown in FIG.6 ;

FIG. 9 is a side view of components of one embodiment of a surgicalsystem in accordance with the principles of the present disclosure;

FIG. 10 is a cross section view of the components shown in FIG. 9 ;

FIG. 11 is a side view of the components shown in FIG. 9 ;

FIG. 12 is a cross section view of the components shown in FIG. 9 ;

FIG. 13 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 14 is a lateral view of vertebrae;

FIG. 15 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 16 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 17 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 18 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 19 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 20 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 21 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 22 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 23 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 24 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 25 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 26 is a perspective view in part cutaway of components of oneembodiment of a surgical system in accordance with the principles of thepresent disclosure;

FIG. 27 is a perspective view in part cutaway of components of oneembodiment of a surgical system in accordance with the principles of thepresent disclosure;

FIG. 28 is a perspective view in part cutaway of components of oneembodiment of a surgical system in accordance with the principles of thepresent disclosure;

FIG. 29 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 30 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 31 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 32 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 33 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 34 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 35 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 36 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 37 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae; and

FIG. 38 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure disposed with vertebrae.

DETAILED DESCRIPTION

The exemplary embodiments of the system and related methods of usedisclosed are discussed in terms of medical devices for the treatment ofmusculoskeletal disorders and more particularly, in terms of a surgicalsystem and method for correction of a spine disorder. In someembodiments, the present surgical system comprises a spinal constructthat can be employed with one or more surgical instruments for a pediclesubtraction osteotomy (PSO). In some embodiments, the present surgicalsystem can be employed with a posterior vertebral column resection tocorrect angular and fixed kyphotic deformity, such as post traumaticdeformity, congenital deformity and/or post infectious deformity.

In some embodiments, the present surgical system comprises a spinalconstruct that can be employed with one or more surgical instruments forthree column manipulation of vertebrae. In some embodiments, the presentsurgical system comprises a spinal construct that can be employed withone or more surgical instruments for compressing, distracting orotherwise manipulating the spine. In some embodiments, the spinalconstruct is configured to spread an applied load to multiple bonescrews to avoid pedicle screw plow and/or bone fracture. In someembodiments, the spinal construct comprises a connector that quickly andeffectively bridges two screws in-situ while maintaining a low profilefor improved visualization.

In some embodiments, the present surgical system includes connectorsthat lock onto bone screws and a rod by engaging a surgical inserterinstrument into a rod slot of the bone screws. In some embodiments, thepresent surgical system is employed with a method that facilitatesapplying the connectors to the bone screws. In some embodiments, thesurgical instruments can be quickly clicked on and off of theconnectors. In some embodiments, the present surgical system isconfigured to provide surgeons with an efficient way to share loadbetween bone screws and reduce the occurrence of screw plow and theresulting risk of bone fracture, screw toggle and screw pull out.

In some embodiments, the present surgical system is employed with amethod that includes the steps of inserting bone screws in two vertebraeabove and two vertebrae below a PSO site. In some embodiments, thepresent surgical system can include multi-axial screws (MAS) and/or dualrod multi-axial screws (DRMAS). In some embodiments, the method includesthe step of attaching a rod instrument with an integrated set screw to abone screw. The set screw attaches the rod instrument proximal to thePSO. In some embodiments, the method includes the step of securing aninstrument with an integrated set screw to a distal end of the rodinstrument. In some embodiments, the method includes the step ofattaching a rack distractor/compressor with numerous motion points tothe spinal construct. In some embodiments, the method includes the stepof locking all motion points to secure the spine. In some embodiments,the present surgical system can include various instruments. In someembodiments, an angle indicating osteotome can be used to guide a cutangle of selected vertebrae. In some embodiments, the method includesthe step of placing an intrabody implant in the PSO to preserve anteriorheight, maintain alignment of the two sides of the PSO and act as afulcrum for closure. In some embodiments, the method includes the stepof setting the rack to compression and unlocking one of the motionpoints to allow the spine to pivot at the PSO during closure.

In some embodiments, the present surgical system comprises a spinalconstruct that includes a connector body, a connector collar, aconnector shaft, connector legs, connector feet and a rod. In someembodiments, the present surgical system comprises a surgical instrumentthat includes a driver, a sleeve and a spring latch. In someembodiments, the surgical instrument comprises an inserter that includesa sleeve and a driver assembly that slides over the spinal construct. Insome embodiments, the surgical instrument comprises spring loadedlatches that retain the connector body in the sleeve. In someembodiments, the inserter sleeve fits into a rod slot of a bone screw toorient a head of the bone screw.

In some embodiments, the present surgical system is employed with amethod of attaching the surgical instrument with the spinal constructincluding the steps of pushing the driver toward the bone screw suchthat it translates through the sleeve and drives the connector collardown the legs. In some embodiments, a change in the connector legprofile causes the legs to close when the collar is down, and open whenthe collar is in an up position. In some embodiments, the connector isspring loaded to an open position such that the legs close and engageslots on the sides of the screw head. As such, the collar can translatedown the legs and engage the rod to bind the rod between the sleeve andthe connector feet. In some embodiments, the driver is rotated to threadthe connector shaft into the connector body. This configuration locksthe legs and the rod.

In some embodiments, the spring latches are engaged to remove theinserter from the spinal construct. In some embodiments, this engagementbinds the screw heads in 5 of 6 degrees of freedom such that the screwheads are free to roll in a medial lateral direction. In someembodiments, surgical instruments can now click onto the spinalconstruct using the sleeve and spring latch quick connect engagement. Insome embodiments, a distractor/compressor connects two spinal constructsto stabilize and manipulate the spine during a PSO procedure.

In some embodiments, the present surgical system includes a surgicalinstrument that can compress or distract and restore curvature of aspine. In some embodiments, the present surgical system includesinstruments and tools for correcting a sagittal deformity andrebalancing a spine of a body. In some embodiments, the present surgicalsystem is employed to treat degenerative deformities of a spine in asagittal plane, for example, ankylosing spondylitis. In someembodiments, the present surgical system is employed to treathyper-kyphosis, flat lumbar back and cervical hyper lordosis, includingdisorders that create an unbalance of a body and loss of alignmentbetween body parts. In some embodiments, the present surgical systemprovides a selected amount of correction to apply a selected balance toa spine and provides control and adjustment to the amount of correction.In some embodiments, the present surgical system includes a series oftools and instruments that allow formulation of a type of correctionapplied and can control the correction stabilization using posteriorinstrumentation.

In some embodiments, the present surgical system is employed with amethod that includes the steps of providing two surgical instruments,such, as for example, two controllers. The controllers are each providedwith joints of the controllers in an open and/or loose configuration. Insome embodiments, the method includes ensuring that all joints are inthe open and/or loose configuration and loosening any joints that arenot in the open and/or loose configuration.

In some embodiments, spinal constructs, such as, for example, temporaryrods or temporary installment bars are attached with implanted screws.The screws can include one or more MAS and/or one or more DRMAS. In someembodiments, first screws are implanted along a lateral side ofvertebrae and second screws are implanted along a contralateral side ofthe vertebrae. A first arm of the first controller is attached to afirst pair of the first screws and a second arm of the first controlleris attached to a second pair of the first screws. A first arm of thesecond controller is attached to a first pair of the second screws and asecond arm of the second controller is attached to a second pair of thesecond screws.

In some embodiments, the screws are attached to the arms of thecontrollers. In some embodiments, the arms are attached to the screws byattaching sleeves of the controllers to implant components, such as, forexample, the spinal constructs. In some embodiments, the arms areattached to the screws by attaching sleeves of the controllers directlyto the screws. In some embodiments, the controllers are each connecteddirectly to multiple vertebral levels. In some embodiments, the arms areconnected to screws implanted, or to be implanted, in the farthestseparated vertebrae. For example, when five vertebral levels areaffected, the arms would be connected to screws implanted in the firstand fifth vertebrae. This can provide the surgeon with more room inwhich to operate, including more room for manipulating the controllersand/or more room for performing related work, such as, for example,vertebral body removal and/or disc removal.

In some embodiments, first level joints of the controllers aretightened, while ensuring that the vertebrae are positioned as desired.In some embodiments, the first level joints are a distalmost joint ofeach of the controllers. In some embodiments, second level joints of thecontrollers are tightened, while ensuring that the vertebrae arepositioned as desired. In some embodiments, third level joints of thecontrollers are tightened, while ensuring that the vertebrae arepositioned as desired. In some embodiments, rack locks of thecontrollers are tightened, while ensuring that the vertebrae arepositioned as desired.

In some embodiments, the vertebrae are distracted after at least one ofthe joints and/or the rack locks are tightened. In some embodiments, thevertebrae are distracted using a rack mechanism of at least one of thecontrollers.

In some embodiments, a surgical procedure, such as, for example,discectomy, laminectomy, fusion, laminotomy, laminectomy, nerve rootretraction, foraminotomy, facetectomy, decompression, spinal nucleus ordisc replacement is performed after the vertebrae are distracted.

In some embodiments, the vertebrae are distracted after the surgicalprocedure is performed to better accommodate an interbody implant. Insome embodiments, the vertebrae are distracted using a rack mechanism ofat least one of the controllers. In some embodiments, the interbodyimplant is relatively large or is specially designed. For example, insome embodiments, the interbody implant has a fore-aft or lateral heighttaper. In some embodiments, the vertebrae are distracted using one ofthe controllers and not the other controller. In some embodiments, thevertebrae are distracted using one of the controllers more than theother controller. In some embodiments, the vertebrae are distracted byone of the controllers and are compressed by the other controller. Insome embodiments, adjustments to the vertebrae are accomplished using arack mechanism of at least one of the controllers and/or adjusting oneor more of the joints.

In some embodiments, a second surgical procedure, such as, for example,discectomy, laminectomy, fusion, laminotomy, laminectomy, nerve rootretraction, foraminotomy, facetectomy, decompression, spinal nucleus ordisc replacement is performed after the surgical procedure is performedand the vertebrae are distracted.

In some embodiments, the vertebrae are compressed after the secondsurgical procedure is performed to assist/cause the vertebrae to locateas desired to post-operation positioning, which may includeassisting/causing the vertebrae to capture or more robustly engage theimplant as desired, for example, at a preferred angle, or with a desiredforce. In some embodiments, the vertebrae are compressed using a rackmechanism of at least one of the controllers. In some embodiments, thevertebrae are compressed using one of the controllers and not the othercontroller. In some embodiments, the vertebrae are compressed using oneof the controllers more than the other controller. In some embodiments,the vertebrae are distracted by one of the controllers and arecompressed by the other controller. In some embodiments, adjustments tothe vertebrae are accomplished using a rack mechanism of at least one ofthe controllers and/or adjusting one or more of the joints.

The controllers are removed from the screws. In embodiments that includeusing the spinal constructs, the spinal constructs are removed from thescrews. After the controllers are removed and the spinal constructs, ifused, are removed, a first permanent spinal rod is installed with eachof the first screws and a second permanent spinal rod is installed witheach of the second screws.

In some embodiments, the present surgical system is employed with amethod that includes a plurality of steps, wherein steps may be added,omitted, or performed in any order. For example, in some embodiments, auser can attach sleeves of a first controller to a first pair of screws,then proceed to tighten joint(s) of the second controller, beforetightening second level joints of the first controller. In someembodiments, first level joint(s) of the first controller is/aretightened, and first level joint(s) of the second controller is/aretightened before tightening second level joints of the first controller.In some embodiments, first level joint(s) of the first controller is/aretightened and at least one of the first level joints of the secondcontroller are tightened before tightening first level joints of thefirst controller. In some embodiments, first level joint(s) of the firstcontroller is/are tightened and at least one of the first level jointsof the second controller are tightened before tightening second leveljoints of the first controller.

In some embodiments, one or more surgical procedure, such as, forexample, removing one or more vertebrae, removing one or more vertebralbody, removing one or more vertebral disc and implanting an interbodyimplant is/are performed before and/or after the vertebrae aredistracted and/or contracted. For example, in some embodiments, at leastone of the surgical procedures is performed. The vertebrae are thendistracted after at least one of the surgical procedures is performed.At least one of the surgical procedures is then performed after thevertebrae are distracted. The vertebrae are then distracted a secondtime after at least one of the surgical procedures is performed. Atleast one of the surgical procedures is then performed after thevertebrae are distracted for the second time. The vertebrae are thencontracted. At least one of the surgical procedures is then performedafter the vertebrae are contracted.

In some embodiments, at least one of the surgical procedures isperformed. The vertebrae are then distracted after at least one of thesurgical procedures is performed. At least one of the surgicalprocedures is then performed after the vertebrae are distracted. Atleast one of the joints is tightened and/or loosened after at least oneof the surgical procedures is performed. At least one of the surgicalprocedures is then performed after at least one of the surgicalprocedures is performed. The vertebrae are then contracted. At least oneof the surgical procedures is then performed after the vertebrae arecontracted.

In some embodiments, one or all of the components of the surgical systemare disposable, peel-pack, pre-packed sterile devices used with animplant. One or all of the components of the surgical system may bereusable. The surgical system may be configured as a kit with multiplesized and configured components.

In some embodiments, the present disclosure may be employed to treatspinal disorders such as, for example, degenerative disc disease, discherniation, osteoporosis, spondylolisthesis, stenosis, scoliosis andother curvature abnormalities, kyphosis, tumor and fractures. In someembodiments, the present disclosure may be employed with other ostealand bone related applications, including those associated withdiagnostics and therapeutics. In some embodiments, the disclosedsurgical system and methods may be alternatively employed in a surgicaltreatment with a patient in a prone or supine position, and/or employvarious surgical approaches to the spine, including anterior, posterior,posterior mid-line, lateral, postero-lateral, and/or antero-lateralapproaches, and in other body regions. The present disclosure may alsobe alternatively employed with procedures for treating the lumbar,cervical, thoracic, sacral and pelvic regions of a spinal column. Thesystem and methods of the present disclosure may also be used onanimals, bone models and other non-living substrates, such as, forexample, in training, testing and demonstration.

The present disclosure may be understood more readily by reference tothe following detailed description of the embodiments taken inconnection with the accompanying drawing figures, which form a part ofthis disclosure. It is to be understood that this application is notlimited to the specific devices, methods, conditions or parametersdescribed and/or shown herein, and that the terminology used herein isfor the purpose of describing particular embodiments by way of exampleonly and is not intended to be limiting. In some embodiments, as used inthe specification and including the appended claims, the singular forms“a,” “an,” and “the” include the plural, and reference to a particularnumerical value includes at least that particular value, unless thecontext clearly dictates otherwise. Ranges may be expressed herein asfrom “about” or “approximately” one particular value and/or to “about”or “approximately” another particular value. When such a range isexpressed, another embodiment includes from the one particular valueand/or to the other particular value. Similarly, when values areexpressed as approximations, by use of the antecedent “about,” it willbe understood that the particular value forms another embodiment. It isalso understood that all spatial references, such as, for example,horizontal, vertical, top, upper, lower, bottom, left and right, are forillustrative purposes only and can be varied within the scope of thedisclosure. For example, the references “upper” and “lower” are relativeand used only in the context to the other, and are not necessarily“superior” and “inferior”.

As used in the specification and including the appended claims,“treating” or “treatment” of a disease or condition refers to performinga procedure that may include administering one or more drugs to apatient (human, normal or otherwise or other mammal), employingimplantable devices, and/or employing instruments that treat thedisease, such as, for example, microdiscectomy instruments used toremove portions bulging or herniated discs and/or bone spurs, in aneffort to alleviate signs or symptoms of the disease or condition.Alleviation can occur prior to signs or symptoms of the disease orcondition appearing, as well as after their appearance. Thus, treatingor treatment includes preventing or prevention of disease or undesirablecondition (e.g., preventing the disease from occurring in a patient, whomay be predisposed to the disease but has not yet been diagnosed ashaving it). In addition, treating or treatment does not require completealleviation of signs or symptoms, does not require a cure, andspecifically includes procedures that have only a marginal effect on thepatient. Treatment can include inhibiting the disease, e.g., arrestingits development, or relieving the disease, e.g., causing regression ofthe disease. For example, treatment can include reducing acute orchronic inflammation; alleviating pain and mitigating and inducingre-growth of new ligament, bone and other tissues; as an adjunct insurgery; and/or any repair procedure. Also, as used in the specificationand including the appended claims, the term “tissue” includes softtissue, ligaments, tendons, cartilage and/or bone unless specificallyreferred to otherwise.

The following discussion includes a description of a surgical system andrelated methods of employing the surgical system in accordance with theprinciples of the present disclosure. Alternate embodiments are alsodisclosed. Reference is made to the exemplary embodiments of the presentdisclosure, which are illustrated in the accompanying figures. Turningto FIGS. 1 and 2 , there are illustrated components of a surgicalsystem, such as, for example, a spinal correction system 10.

The components of spinal correction system 10 can be fabricated frombiologically acceptable materials suitable for medical applications,including metals, synthetic polymers, ceramics and bone material and/ortheir composites. For example, the components of spinal correctionsystem 10, individually or collectively, can be fabricated frommaterials such as stainless steel alloys, commercially pure titanium,titanium alloys, Grade 5 titanium, super-elastic titanium alloys,cobalt-chrome alloys, superelastic metallic alloys (e.g., Nitinol, superelasto-plastic metals), ceramics and composites thereof such as calciumphosphate (e.g., SKELITE™), thermoplastics such as polyaryletherketone(PAEK) including polyetheretherketone (PEEK), polyetherketoneketone(PEKK) and polyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO₄polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone,polyurethane, silicone-polyurethane copolymers, polymeric rubbers,polyolefin rubbers, hydrogels, semi-rigid and rigid materials,elastomers, rubbers, thermoplastic elastomers, thermoset elastomers,elastomeric composites, rigid polymers including polyphenylene,polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone materialincluding autograft, allograft, xenograft or transgenic cortical and/orcorticocancellous bone, and tissue growth or differentiation factors,partially resorbable materials, such as, for example, composites ofmetals and calcium-based ceramics, composites of PEEK and calcium basedceramics, composites of PEEK with resorbable polymers, totallyresorbable materials, such as, for example, calcium based ceramics suchas calcium phosphate, tri-calcium phosphate (TCP), hydroxyapatite(HA)-TCP, calcium sulfate, or other resorbable polymers such aspolyaetide, polyglycolide, polytyrosine carbonate, polycaroplaetohe andtheir combinations.

Various components of spinal correction system 10 may have materialcomposites, including the above materials, to achieve various desiredcharacteristics such as strength, rigidity, elasticity, compliance,biomechanical performance, durability and radiolucency or imagingpreference. The components of spinal correction system 10, individuallyor collectively, may also be fabricated from a heterogeneous materialsuch as a combination of two or more of the above-described materials.The components of spinal correction system 10 may be monolithicallyformed, integrally connected or include fastening elements and/orinstruments, as described herein.

Spinal correction system 10 is employed, for example, with a minimallyinvasive procedure, including percutaneous techniques, mini-open andopen surgical techniques to deliver and introduce instrumentation and/orcomponents of spinal constructs at a surgical site within a body of apatient, for example, a section of a spine. In some embodiments, one ormore of the components of spinal correction system 10 are configured forengagement with spinal constructs attached with vertebrae to manipulatetissue and/or correct a spinal disorder, such as, for example, asagittal deformity, as described herein. In some embodiments, spinalcorrection system 10 may be employed with surgical procedures, such as,for example, corpectomy, discectomy and/or fracture/trauma treatment andmay include fusion and/or fixation that employ implants to restore themechanical support function of vertebrae.

Spinal correction system 10 includes a spinal construct, such as, forexample, a connector 12. Connector 12 is engageable with bone fastenersand a surgical instrument to manipulate tissue, as described herein.Connector 12 includes a member 16 and a member 116. Member 16 includes abody, such as, for example, a support 18. Support 18 includes a wall 20that extends between an end 22 and an end 24. Wall 20 includes a surface26 and a surface 28 that extend between ends 22, 24. Wall 20 extendsparallel to an axis X1 defined by a longitudinal element, such as, forexample, a rod 36, as described herein. In some embodiments, wall 20 mayextend in alternate configurations, for example, arcuate, offset,staggered and/or angled portions.

Wall 20 includes an extension, such as, for example, a leg 30. Leg 30extends from end 22. Leg 30 is oriented substantially perpendicular toaxis X1. In some embodiments, leg 30 may be variously oriented relativeto axis X1, such as, for example, transverse and/or angled. Leg 30includes a tapered configuration to facilitate engagement with areceiver of a fastener, as described herein.

Leg 30 includes a surface 32 that defines a recess 34. Recess 34 isarcuate to facilitate engagement with rod 36. In some embodiments, leg30 is monolithically formed with rod 36. In some embodiments, leg 30 isattached with rod 36 via clips, hooks, adhesives and/or flanges. In someembodiments, surface 32 is smooth or even. In some embodiments, surface32 may be rough, textured, porous, semi-porous, dimpled and/or polished.

Wall 20 includes an extension, such as, for example, a leg 40 disposedin spaced apart relation to leg 30. Leg 40 extends from end 24. Leg 40is oriented substantially perpendicular to axis X1. In some embodiments,leg 40 may be variously oriented relative to axis X1, such as, forexample, transverse and/or angled. Leg 40 includes a taperedconfiguration configured to facilitate engagement with a receiver of afastener, as described herein.

Leg 40 includes a surface 42 that defines a recess 44. Recess 44 isarcuate to facilitate engagement with rod 36. In some embodiments, leg40 is monolithically formed with rod 36. In some embodiments, leg 40 isattached with rod 36 via clips, hooks, adhesives and/or flanges. In someembodiments, surface 42 is smooth or even. In some embodiments, surface42 may be rough, textured, porous, semi-porous, dimpled and/or polished.

Rod 36 extends between an end 50 and an end 52 defining axis X1, asdescribed herein. Rod 36 includes a surface 54 configured for engagementwith a coupling member of support 116, as described herein. In someembodiments, rod 36 is configured to connect the receiver of onefastener with the receiver of an adjacent fastener to connect members16, 116, as described herein.

Wall 20 includes an inner surface 62 that defines a cavity 64 extendingbetween surfaces 26, 28. Cavity 64 is configured for disposal of acoupling member, such as, for example, a set screw 80. In someembodiments, set screw 80 is integrally connected with member 16. Setscrew 80 is configured to fix support 16 and rod 36 with the receiver ofa bone fastener, as described herein.

Connector 12 includes a member 116. Member 116 includes a body, such as,for example, a support 118. Support 118 includes a wall 120 that extendsbetween an end 122 and an end 124. Wall 120 includes a surface 126 and asurface 128 that extend between ends 122, 124. In some embodiments, wall120 may extend in alternate configurations between ends 122, 124, suchas, for example, linear, arcuate, offset, staggered and/or angledportions.

Wall 120 includes an extension, such as, for example, a leg 130. Leg 130extends from end 122. Leg 130 is oriented substantially perpendicular toaxis X1. In some embodiments, leg 130 may be variously oriented relativeto axis X1, such as, for example, transverse and/or angled, which mayinclude acute and obtuse orientations. In some embodiments, leg 130 mayhave various configurations, for example, round, oval, rectangular,tapered, polygonal, irregular, offset, staggered, uniform andnon-uniform.

Leg 130 includes a surface 132 that defines a recess 134. Recess 134 isconfigured for engagement with rod 36 to facilitate connection of member16 with member 116 and adjacent bone fasteners, as described herein. Insome embodiments, the geometry of recess 134 may be arcuate tofacilitate engagement with rod 36. In some embodiments, surface 132 issmooth or even. In some embodiments, surface 132 may be rough, textured,porous, semi-porous, dimpled and/or polished.

Leg 130 includes a surface 136 that defines a mating element, such as,for example, a detent 138. Detent 138 is configured for a matingengagement with various surgical instruments in a quick releaseconfiguration to facilitate the interchangeability of connector 12 withsurgical instruments, as described herein. In some embodiments, detent138 includes a circular configuration. In some embodiments the crosssection geometry of detent 138 may have various configurations, such as,for example, oval, oblong, triangular, polygonal having planar orarcuate side portions, irregular, uniform, non-uniform, consistent,variable, horseshoe shape, U-shape or kidney bean shape. In someembodiments, surface 136 may have alternate surface configurations, suchas, for example, rough, threaded for connection with surgicalinstruments, arcuate, undulating, porous, semi-porous, dimpled, polishedand/or textured. Detents 138 are configured for releasable engagementwith a surgical instrument to manipulate tissue such that movement ofthe receiver relative to a shaft of the fastener is resisted and/orprevented.

Wall 120 includes an extension, such as, for example, a leg 140,disposed in a spaced apart relation with leg 130. In some embodiments,leg 140 extends from end 124. Leg 140 is oriented substantiallyperpendicular to axis X1. In some embodiments, leg 140 may be variouslyoriented relative to axis X1, such as, for example, transverse and/orangled.

Leg 140 includes a surface 142 that defines a recess 144. Recess 144 isarcuate to facilitate engagement with rod 36. In some embodiments,surface 142 is smooth or even. In some embodiments, surface 142 may berough, textured, porous, semi-porous, dimpled and/or polished.

Leg 140 includes a surface 146 that defines a mating element, such as,for example, a detent 148. Detent 148 is configured for a matingengagement with various surgical instruments in a quick releaseconfiguration, as described herein, to facilitate the interchangeabilityof connector 12 with surgical instruments, as described herein. In someembodiments, detent 148 includes a circular configuration. In someembodiments, detent 148 may have various configurations, such as, forexample, oval, oblong, triangular, polygonal having planar or arcuateside portions, irregular, uniform, non-uniform, consistent, variable,horseshoe shape, U-shape or kidney bean shape. In some embodiments,surface 146 may have alternate configurations, such as, for example,rough, threaded for connection with surgical instruments, arcuate,undulating, porous, semi-porous, dimpled, polished and/or textured.

Wall 120 includes an extension 150. Extension 150 extends from wall 120between ends 122, 124. Extension 150 connects legs 130, 140. Extension150 is oriented substantially perpendicular to axis X1. In someembodiments, extension 150 may be variously oriented relative to axisX1, such as, for example, transverse and/or angled. Wall 120 includes anextension 160. Extension 160 extends from wall 120 between ends 122, 124in a spaced apart relation relative to extension 150. Extension 160connects legs 130, 140. Extension 160 is oriented substantiallyperpendicular to axis X1. In some embodiments, extension 160 may bevariously oriented relative to axis X1, such as, for example, transverseand/or angled.

Wall 120 includes an inner surface 172 that defines an axial cavity 174extending between surfaces 126, 128. Cavity 174 is configured fordisposal of a coupling member, such as, for example, a set screw 180. Insome embodiments, set screw 180 is integrally connected with member 116.Set screw 180 is configured to fix support 116 with the receiver of abone fastener, as described herein. Set screw 180 includes a surface192. Surface 192 is configured to engage a surface 54 of rod 36 toconnect support 16 with support 116 forming connector 12.

Spinal correction system 10 includes a bone fastener, such as, forexample, a multi-axial screw (MAS) 200, as shown in FIG. 3 . MAS 200 isconfigured for engagement with tissue, as described herein. MAS 200includes a receiver 202 having a pair of spaced apart arms 204, 204 a.Receiver 202 is configured for engagement with member 16 and/or member116, as described herein.

Arms 204, 204 a include an inner surface that defines a U-shapedpassageway 206. Passageway 206 is configured for disposal of rod 36, asdescribed herein. In some embodiments, all or only a portion ofpassageway 206 may have alternate cross section configurations, such as,for example, oval, oblong, triangular, square, polygonal, irregular,uniform, non-uniform, offset, staggered, and/or tapered. In someembodiments, arms 204, 204 a may be disposed at alternate orientations,relative to a longitudinal axis of MAS 200, such as, for example,transverse, perpendicular and/or other angular orientations such asacute or obtuse, co-axial and/or may be offset or staggered.

The inner surface of receiver 202 includes a thread form configured forengagement with set screw 80 and/or set screw 180. Set screws 80, 180are threaded with receiver 202 to attach, fix and/or lock member 16and/or member 116 with MAS 200 attached with tissue to facilitateconnection of the tissue with surgical instruments for correctiontreatment, as described herein.

MAS 200 includes a shaft 208 configured for penetrating tissue. Shaft208 has a cylindrical cross-sectional configuration and includes anouter surface having an external thread form. In some embodiments, theexternal thread form may include a single thread or a plurality ofdiscrete threads. In some embodiments, other engaging structures may belocated on shaft 208, such as, for example, a nail configuration, barbs,expanding elements, raised elements and/or spikes to facilitateengagement of shaft 208 with tissue.

In some embodiments, all or only a portion of shaft 208 may havealternate cross section configurations, such as, for example, oval,oblong, triangular, square, polygonal, irregular, uniform, non-uniform,offset, staggered, undulating, arcuate, variable and/or tapered. In someembodiments, the outer surface of shaft 208 may include one or aplurality of openings. In some embodiments, all or only a portion of theouter surface of shaft 208 may have alternate surface configurations toenhance fixation with tissue, such as, for example, rough, arcuate,undulating, mesh, porous, semi-porous, dimpled and/or textured. In someembodiments, all or only a portion of shaft 208 may be disposed atalternate orientations, relative to its longitudinal axis, such as, forexample, transverse, perpendicular and/or other angular orientationssuch as acute or obtuse, co-axial and/or may be offset or staggered. Insome embodiments, all or only a portion of shaft 208 may be cannulated.

Spinal correction system 10 includes a bone fastener, such as, forexample, a dual rod multi-axial screw (DRMAS) 220, as shown in FIG. 4 .DRMAS 220 is configured for engagement with tissue, as described herein.DRMAS 220 includes a receiver 222. Receiver 222 includes a spaced apartarms 226, 226 a, 226 b. Arms 226, 226 a include an inner surface thatdefines a U-shaped passageway 228. The inner surface of passageway 206includes a thread form configured for engagement with set screws 80and/or 180. Set screws 80, 180 are threaded with arms 226, 226 a toattach, fix and/or lock member 16 and/or member 116 with receiver 222,as described herein. Spaced apart arms 226 a, 226 b include an innersurface that defines a U-shaped passageway 230 disposed adjacent topassageway 228. The inner surface of arms 226 a, 226 b includes a threadform configured for engagement with set screw 80 and/or set screw 180 toattach, fix and/or lock member 16 and/or member 116 with receiver 222.

MAS 220 includes a shaft 232, similar to shaft 208, configured forpenetrating tissue. In some embodiments, one or more of the bonefasteners described herein can include posted screws, pedicle screws,uni-axial screws, side loading screws, sagittal adjusting screws,transverse sagittal adjusting screw, sagittal angulation screws,uni-planar screws, facet screws, fixed screws, tissue penetratingscrews, conventional screws, expanding screws, wedges, anchors, buttons,clips, snaps, friction fittings, compressive fittings, expanding rivets,staples, nails, adhesives, posts, fixation plates and/or posts. In someembodiments, one or more of the bone fasteners may be engaged withtissue in various orientations, such as, for example, series, parallel,offset, staggered and/or alternate vertebral levels.

Spinal correction system 10 includes a surgical instrument, such as, forexample, a compressor/distractor 250, as shown in FIG. 5 .Compressor/distractor 250 includes a longitudinal element, such as, forexample, a rack 252. Rack 252 extends between an end 254 and an end 256defining a longitudinal axis A1. In some embodiments, rack 252 includesan outer surface 258 having a plurality of teeth, such as, for example,splines 260 engageable with an arm, as described herein.

Rack 252 includes an arm 262 extending from end 254. Arm 262 includes apart 264 and a part 266. Part 264 extends between an end 268 and an end270. End 268 is configured for connection with rack 252. In someembodiments, part 264 is monolithically formed with rack 252. In someembodiments, end 268 is attached with rack 252 with, for example, clips,hooks, adhesives and/or flanges. In some embodiments, all or only aportion of part 264 may include cross section configurations, such as,for example, oval, oblong, triangular, square, polygonal, irregular,uniform, non-uniform, offset, staggered, undulating, arcuate, variableand/or tapered. In some embodiments, rack 252 and part 264 define ajoint, such as, for example a third level joint of arm 262 configured toallow part 264 to pivot relative to rack 252 in the directions shown byarrows A in FIG. 5 . Locking mechanism 276 may be manipulated to tightenthe third level joint of arm 262 to fix part 264 relative to rack 252.Locking mechanism 276 may be manipulated to loosen the third level jointof arm 262 to allow part 264 to pivot relative to rack 252.

End 270 includes a surface that defines a cavity 272. Cavity 272 isconfigured for disposal of part 266. In some embodiments, cavity 272includes a pin hinge 274 configured to facilitate a pivotable connectionwith part 266. Pin hinge 274 facilitates rotation of part 266 relativeto part 264. Part 266 is configured to rotate relative to part 264, inthe directions shown by arrows A in FIG. 5 . In some embodiments, part264 includes a locking mechanism 276 configured to fix part 266 relativeto part 264. In some embodiments, hinge pin 274 defines a joint, suchas, for example a second level joint of arm 262 configured to allow part266 to pivot relative to part 264 in the directions shown by arrows A inFIG. 5 . Locking mechanism 276 may be manipulated to tighten the secondlevel joint of arm 262 to fix part 266 relative to part 264, asdiscussed herein. Locking mechanism 276 may be manipulated to loosen thesecond level joint of arm 262 to allow part 266 to pivot relative topart 264, as discussed herein.

Part 266 extends between an end 278 and an end 280 and defines an axisL2. End 278 includes a surface that defines a cavity 282. Cavity 282 isconfigured for disposal of pin 274 and connection with part 264, asdescribed herein. End 280 includes an extension, such as, for example, arod 284. In some embodiments, rod 284 extends transverse to axis L2. Insome embodiments, all or only a portion of rod 284 may be disposed atalternate orientations, relative to axis L2, such as, for example,perpendicular and/or other angular orientations such as acute or obtuse,co-axial and/or may be offset or staggered. Rod 284 includes a surface286 configured for engagement with a body, such as, for example, asleeve 290, as shown in FIGS. 6-8 . In some embodiments, surface 286includes a circumferential lip 288 configured to resist and/or preventdisengagement of rod 284 from sleeve 290. Rod 284 is configured tofacilitate rotation of sleeve 290 relative to arm 262, in the directionsshown by arrows D and arrows E in FIG. 6 in a non-locking orientation,as described herein.

Sleeve 290 extends between an end 292 and an end 294 defining an axisL3. End 292 is connected with rod 284 by a lock 296. Sleeve 290 isdisposable in a non-locking orientation for rotation relative to rod284, in the direction shown by arrows D in FIG. 6 . Lock 296 isconfigured to fix sleeve 290 relative to rod 284 in a locked orientationto resist and/or prevent rotation of sleeve 290 relative to rod 284, asdescribed herein.

Lock 296 includes a collar 298 that extends between an end 302 and anend 304. End 302 includes a circumferential flange 306 configured forengagement with a screw 324 to facilitate translation of collar 298, asdescribed herein. Engagement of flange 306 with screw 324 facilitatestranslation of collar 298 into the non-locking orientation.

Screw 324 includes a head 326 and a threaded shaft 328. In someembodiments, head 326 includes a hexagonal cross-section. In someembodiments, head 326 may have alternative cross-sections, such as, forexample, rectangular, polygonal, hexalobe, oval, irregular, cruciform,phillips, square, polygonal or star cross sectional configuration.

Screw 324 includes a circumferential ring 340 configured to engageflange 306. Ring 340 is disposed between head 326 and shaft 328.Engagement of flange 306 with collar 298 facilitates translation ofcollar 298 into the non-locking orientation. In some embodiments, screw324 includes a knob 330. Knob 330 includes a gripping surface 332configured to facilitate rotation of screw 324. Knob 330 includes asurface 333 that defines a cavity 334. Cavity 334 is configured for amating engagement with head 326. In some embodiments, cavity 334includes a hexagonal cross-section to mate with head 326. In someembodiments, cavity 334 may have alternative cross-sections, such as,for example, rectangular, polygonal, hexalobe, oval, irregular,cruciform, phillips, square, polygonal or star cross sectionalconfiguration.

Shaft 328 includes a surface 335 configured to engage surface 286 of rod284. Rotation of screw 324 in a clockwise direction causes screw totranslate into engagement with rod 284 to fix rod 284 with sleeve 290 inthe locked orientation to resist and/or prevent rotation of sleeve 290relative to rod 284. Surface 335 is configured to apply a force to rod284 to fix sleeve 290 relative to rod 284. Engagement of screw 324 withrod 284 is configured to fix rod 284 between screw 324 and collar 298preventing rotation of sleeve 290 about rod 284. Rotation of screw 324in a counter clockwise direction causes screw to translate out ofengagement with rod 284 into the non-locking orientation to allowrotation of sleeve 290 relative to rod 284.

Collar 298 includes a surface 308 that defines an opening 310. Opening310 is configured for disposal of rod 284. In some embodiments, all oronly a portion of opening 310 may include cross section configurations,such as, for example, oval, oblong, triangular, square, polygonal,irregular, uniform, non-uniform, offset, staggered, undulating, arcuate,variable and/or tapered. Collar 298 includes a surface 312 that definesa cavity 314. Cavity 314 is configured for disposal of a shaft 300, asdescribed herein. In some embodiments, cavity 314 extends along axis L3.In some embodiments, all or only a portion of cavity 314 may be disposedat alternate orientations, relative to axis L3, such as, for example,perpendicular and/or other angular orientations such as acute or obtuse,co-axial and/or may be offset or staggered.

End 304 includes a surface 316 that defines an engagement surface, suchas, for example, a splined surface 318. Sleeve 290 is disposable in anon-locking orientation for rotation relative to axis L3, in thedirections shown by arrows E in FIG. 6 . Splines 318 are engageable witha surface of sleeve 290 to fix sleeve 290 relative to arm 262 to resistand/or prevent rotation of sleeve 290, in the directions shown by arrowsE in FIG. 6 . Locking of rod 284 with sleeve 290 causes splines 318 totranslate axially into engagement with sleeve 290 to fix sleeve 290relative to arm 266 and axis L3. Splines 318 are configured fortranslation in a second, opposite direction out of engagement withsleeve 290 to facilitate rotation of sleeve 290 relative to arm 266 andaxis L3.

Shaft 300 includes a surface 344 that defines an opening 346. Opening346 is disposed in alignment with opening 310 to receive and support rod284. Shaft 300 includes a surface 348 that defines a groove 350. Groove350 is circumferentially disposed about surface 348. Groove 350 isconfigured for disposal of pins 352 disposed with sleeve 290. Pins 352and groove 350 engage to prevent shaft 300 from translating whileallowing shaft 300 to rotate relative to sleeve 290. In someembodiments, surface 286 and surface 344 define a joint, such as, forexample a first level joint of arm 262 configured to allow sleeve 290 topivot relative to part 266 in the directions shown by arrows A in FIG. 5. Tightening the first level joint of arm 262 causes screw 324 totranslate into engagement with rod 284 to fix sleeve 290 relative topart 266, as discussed herein. Loosing the first level joint of arm 262causes screw 324 to translate out of engagement with rod 284 to allowsleeve 290 to pivot relative to part 266, as discussed herein.

End 294 of sleeve 290 includes a surface 360 that defines a cavity 362,as shown in FIGS. 8-12 . Cavity 362 includes walls 364 a, 364 b, 364 cand 364 d that define a tubular configuration. In some embodiments,cavity 362 may have alternative cross-sections, such as, for example,rectangular, polygonal, oval, or irregular. Cavity 362 includes aportion 366 and a portion 368. Portion 366 includes a surface 370 thatdefines a recess 372. Recess 372 includes a female receptacle, such as,for example, a channel 374. Channel 374 is configured for disposal ofhead 182 of set screw 180, as shown in FIG. 10 . Portion 368 includes asurface 376 configured for a mating engagement with support 118. Portion366 merges with portion 368 at a surface 378 that defines a ledge 380.Ledge 380 is configured to contact wall 120. Portions 366, 368 areconfigured to guide support 118 into cavity 362. Cavity 362 isconfigured to capture and engage support 118, as described herein.

Wall 364 b includes a surface 382 that defines an elongate opening 384.Opening 384 is configured for moveable disposal of an arm, such as, forexample, a latch 400, as described herein. Wall 364 d includes a surface386 that defines an elongate opening 388. Opening 388 is configured formoveable disposal of an arm, such as, for example, a latch 402, asdescribed herein. Latches 400, 402 are configured to engage detents 138,148 to capture support 118.

Latches 400, 402 are configured for relative movement to capture support116 in a quick release configuration, as described herein. Latch 400extends between an end 404 and an end 406. End 404 includes a grippingsurface 408 configured to facilitate manipulation of latch 400. End 406includes a capture element 410. Capture element 410 is configured toengage detent 138. Latch 400 is connected with sleeve 290 by a spring412. Spring 412 is configured to resiliently bias latch 400 in theclosed configuration, as shown in FIG. 11 .

Latch 402 extends between an end 414 and an end 416. End 414 includes agripping surface 418 configured to facilitate manipulation of latch 402.End 416 includes a capture element 420. Capture element 420 isconfigured to engage detent 148. Latch 402 is connected with sleeve 290by a spring 422. Spring 422 is configured to resiliently bias latch 402in the closed configuration, as shown in FIG. 11 . In some embodiments,latches 400, 402 are resiliently biased to a closed configuration tocapture support 118, as shown in FIGS. 11 , and manipulable to an openconfiguration, as shown in FIGS. 9 and 10 . Latches 400, 402 engagesupport 118 in a quick release configuration such that sleeves 290, 290a and supports 118 are connectable in releasably fixed engagement viabiased latches 400, 402 to facilitate intra-operative connection, asdescribed herein. In some embodiments, the quick release configurationof spinal correction system 10 may include threaded connection, clips,dovetail connection, adhesive, key/keyslot, friction fit and/or pressurefit.

Rack 252 includes an arm 562. Arm 562 is configured for axialtranslation along axis A1 relative to arm 262. Arm 562 includes a part564 and a part 566. Part 564 extends between an end 568 and an end 570.End 568 is configured for connection with rack 252. In some embodiments,end 588 includes a lock 600. Lock 600 is configured for manipulation invarious orientations to fix arm 562 in various configurations relativeto arm 262 along rack 252. In some embodiments, lock 600 is oriented toallow translation of arm 562 towards arm 262. In some embodiments, lock600 is oriented to allow translation of arm 462 away from arm 262. Insome embodiments, lock 600 is oriented to allow translation of arm 462towards and away from arm 262. In some embodiments, lock 600 is orientedto resist and/or prevent translation of arm 562 to fix arm 562 with rack252. In some embodiments, end 668 is attached with rack 252 via, forexample, clips, hooks, adhesives and/or flanges. In some embodiments,rack 252 and part 564 define a joint, such as, for example a third leveljoint of arm 562 configured to allow part 564 to pivot relative to rack252 in the directions shown by arrows B in FIG. 5 . Locking mechanism576 may be manipulated to tighten the third level joint of arm 562 tofix part 264 relative to rack 252. Locking mechanism 576 may bemanipulated to loosen the third level joint of arm 562 to allow part 564to pivot relative to rack 252.

End 570 includes a surface that defines a cavity 572. Cavity 572 isconfigured for disposal of part 566, similar to part 266 describedherein. Cavity 572 includes a pin hinge 574 configured to facilitate apivotable connection with part 566. Pin hinge 574 facilitates rotationof part 566 relative to part 564. Part 566 is configured to rotaterelative to part 564, in the directions shown by arrows B in FIG. 5 .Part 564 includes a locking mechanism 576 configured to fix part 566relative to part 564. In some embodiments, hinge 574 defines a joint,such as, for example a second level joint of arm 562 configured to allowpart 566 to pivot relative to part 564 in the directions shown by arrowsB in FIG. 5 . Locking mechanism 576 may be manipulated to tighten thesecond level joint of arm 562 to fix part 566 relative to part 564, asdiscussed herein. Locking mechanism 576 may be manipulated to loosen thesecond level joint of arm 562 to allow part 566 to pivot relative topart 564, as discussed herein.

Part 566 extends between an end 578 and an end 580 and defines an axisL4. End 578 includes a surface that defines a cavity 582. Cavity 582 isconfigured for disposal of pin hinge 574 and connection with part 564,as described herein. End 580 includes a rod 584, similar to rod 284described herein. Rod 584 includes a surface 586 configured forengagement with a sleeve 290 a, similar to sleeve 290 described herein.Surface 586 includes a circumferential lip 588 configured to resistand/or prevent disengagement of rod 584 from sleeve 290 a, similar tothat described herein. Rod 584 is configured to facilitate rotation ofsleeve 290 a relative to arm 562 between a non-locking orientation and alocked orientation, similar to sleeve 290 described herein. In someembodiments, surface 586 and an inner surface of sleeve 290 a define ajoint, such as, for example a first level joint of arm 562 configured toallow sleeve 290 a to pivot relative to part 566 in the directions shownby arrows B in FIG. 5 . Tightening the first level joint of arm 562causes a screw similar to screw 324 to translate into engagement withrod similar to rod 284 to fix sleeve 290 a relative to part 566, asdiscussed herein. Loosening the first level joint of arm 562 causes thescrew to translate out of engagement with the rod to allow sleeve 290 ato pivot relative to part 566, as discussed herein.

In some embodiments, surgical instrument 250 is configured for a directconnection with the receiver of a fixed angle bone fastener 100, asshown in FIG. 13 . In some embodiments, sleeve 290 and/or sleeve 290 aare configured for engagement with the receiver of bone fastener 100 todirect a compression and/or distraction load along a single bonefastener.

In assembly, operation and use, spinal correction system 10 includingspinal construct 12 and surgical instrument 250, similar to the systemsand methods described with regard to FIGS. 1-13 , is employed with asurgical procedure, such as, for example, a PSO for treatment of a spineof a patient including vertebrae V, as shown in FIGS. 14-21 . Spinalcorrection system 10 may also be employed with other surgicalprocedures, such as, for example, discectomy, laminectomy, fusion,laminotomy, laminectomy, nerve root retraction, foramenotomy,facetectomy, decompression, spinal nucleus or disc replacement and bonegraft and implantable prosthetics including plates, rods, and boneengaging fasteners for securement of spinal construct 12.

Spinal correction system 10 is employed with a PSO procedure fortreatment of an applicable condition or injury of an affected section ofa spinal column and adjacent areas within a body. For example, vertebraeV includes a vertebral level V1, a vertebral level V2 and a vertebrallevel V3. Diseased and/or damaged vertebrae and intervertebral discs aredisposed at vertebrae V2 between vertebrae V1 and V3. In someembodiments, components of spinal correction system 10 are configuredfor insertion with a vertebral space to space apart articular jointsurfaces, provide support and maximize stabilization of vertebrae V.

In use, to treat the affected section of vertebrae V, a medicalpractitioner obtains access to a surgical site including vertebrae V, asshown in FIG. 14 , in any appropriate manner, such as through incisionand retraction of tissues. In some embodiments, spinal correction system10 may be used in any existing surgical method or technique includingopen surgery, mini-open surgery, minimally invasive surgery andpercutaneous surgical implantation, whereby vertebrae V is accessedthrough a mini-incision, or sleeve that provides a protected passagewayto the area.

An incision is made in the body of a patient and a cutting instrument(not shown) creates a surgical pathway for implantation of components ofspinal correction system 10. A preparation instrument (not shown) can beemployed to prepare tissue surfaces of vertebrae V, as well as foraspiration and irrigation of a surgical region.

MAS screws 200 are engaged with vertebrae V along a lateral side L ofvertebrae V, as shown in FIG. 15 . In some embodiments, MAS screws 200are disposed in pairs 200 a, 200 b alongside L. In some embodiments,pair 200 a is disposed inferior to vertebra V2 and pair 200 b isdisposed superior to vertebra V2. DRMAS 220 are engaged along acontralateral side CL of vertebrae V, as shown in FIG. 15 . In someembodiments, DRMAS screws 220 are disposed in pairs 220 a, 220 balongside CL. In some embodiments, pair 220 a is disposed inferior tovertebra V2 and pair 220 b is disposed superior to vertebra V2. Thereceivers of MAS 200 and DRMAS 220 are configured to rotate within sixdegrees relative to the shafts.

Support 18 is engaged with pair 200 a such that support 18 is disposedadjacent vertebra V2 and rod 36 extends in an inferior orientation to anadjacent MAS 200, as shown in FIG. 16 . Set screw 80 is engaged withreceiver 202 disposed adjacent vertebrae V2. Support 18 is engaged withpair 200 b such that support 18 is disposed adjacent vertebra V2 and rod36 extends in a superior orientation to an adjacent MAS 200. Set screw80 is engaged with receiver 202 disposed adjacent vertebrae V2.

Support 18 is engaged with pair 220 a such that support 18 is disposedadjacent vertebra V2 and rod 36 extends in an inferior orientation to anadjacent MAS screw 200. Set screw 80 is engaged with receiver 222disposed adjacent vertebrae V2. Support 18 is engaged with pair 220 bsuch that support 18 is disposed adjacent vertebra V2 and rod 36 extendsin a superior orientation to an adjacent MAS 200. Set screw 80 isengaged with receiver 222 disposed adjacent vertebrae V2.

A surgical instrument, such as, for example, a driver is connected withset screw 80 and/or set screw 180 to facilitate engagement of supports18, 118. Support 118 is engaged with pair 200 a such that set screw 180is engaged with the adjacent MAS screw 200 receiver 202 and rod 36, asshown in FIG. 17 . Support 118 is engaged with pair 200 b such that setscrew 180 is engaged with the adjacent receiver 202 and rod 36. Support118 is engaged with pair 220 a such that set screw 180 is engaged withthe adjacent DRMAS 220 receiver 222 and rod 36. Support 118 is engagedwith pair 220 b such that set screw 180 is engaged with the adjacentDRMAS 220 receiver 222 and rod 36.

Engagement of supports 18, 118 with rod 36 and the adjacent bonefasteners construct connector 12. Attachment of connectors 12 with pairs200 a, 200 b, 200 a, 200 b resists and/or prevents movement of thereceivers relative to the shafts and/or vertebrae attached therewith. Insome embodiments, movement of the receivers relative to the shaftsand/or vertebrae can be prevented in one or a plurality of degrees offreedom of the fasteners, as described herein.

Surgical instrument 250 is connected with supports 118 disposedalongside CL of vertebrae V, as shown in FIG. 18 . In some embodiments,part 266 and/or part 566 are rotatable relative to arm 262, arm 562,rack 252, the spinal constructs and/or vertebrae V to orient sleeve 290and/or sleeve 290 a in a selected orientation to capture one or moreconnector 12. In some embodiments, part 266 is fixed in a selectedorientation with locking mechanism 276 and part 566 is fixed in aselected orientation with locking mechanism 576, as described herein.Sleeves 290, 290 a are translated over supports 118 such that captureelements 406, 416 are engaged with detents 138, 148 in a quick releaseconfiguration, as described herein.

In some embodiments, a surgical instrument, such as, for example, anosteotome is utilized to facilitate removing all or a portion ofvertebra V2 and adjacent intervertebral disc tissue to define avertebral space VS, as shown in FIG. 19 . In some embodiments, vertebralspace VS can include posterior portions of the spine, such as, forexample, pedicles, laminae and/or spinous process. In some embodiments,a wedge portion of bone and/or other tissue is removed from a selectedvertebra and adjacent intervertebral disc tissue remains intact.

Lock 600 is manipulated to axially translate arm 562 along rack 252relative to arm 262 to facilitate compression and/or distraction ofvertebrae V. Translation of arm 562 relative to arm 262 along rack 252,in a direction shown by arrow N in FIG. 20 , distracts vertebrae V toopen vertebral space VS. In some embodiments, a spinal implant, such as,for example, an intrabody implant 700 is disposed within vertebral spaceVS, as shown in FIG. 20 . In some embodiments, intrabody implant 700 isconfigured to preserve anterior height and maintain alignment ofvertebrae V. Intrabody implant 700 provides a fulcrum about whichvertebrae V1, V2 are pivoted by surgical instrument 250.

Surgical instrument 250 is manipulated to pivot vertebrae V1, V2 aboutintrabody implant 700. Translation of arm 562, in a direction shown byarrow M in FIG. 21 , is configured to compress vertebrae V to achievecorrection, for example, a selected lordosis. In some embodiments,surgical instrument 250 manipulates vertebrae V during a surgicalcorrection treatment to rotate, displace, pull, twist or align vertebraeV to a selected orientation for sagittal, coronal and/or axialcorrection. In some embodiments, surgical instrument 250 appliesderotation forces to vertebrae V for correction of vertebrae V.

Upon completion of a procedure, as described herein, the surgicalinstruments, assemblies and non-implanted components of spinalcorrection system 10 are removed and the incision(s) are closed. One ormore of the components of spinal correction system 10 can be made ofradiolucent materials such as polymers. Radiomarkers may be included foridentification under x-ray, fluoroscopy, CT or other imaging techniques.In some embodiments, the use of surgical navigation, microsurgical andimage guided technologies may be employed to access, view and repairspinal deterioration or damage, with the aid of spinal correction system10. In some embodiments, spinal correction system 10 may include one ora plurality of plates, connectors and/or bone fasteners for use with asingle vertebral level or a plurality of vertebral levels.

In some embodiments, spinal correction system 10 includes one or aplurality of alternate surgical instruments, each configured for matingengagement in a quick release configuration with spinal constructs, asdescribed herein. This configuration facilitates the interchangeabilityof the spinal constructs with the alternate surgical instruments. Insome embodiments, spinal correction system 10 includes one or aplurality of alternate surgical instruments, such as, for example,inserters, extenders, reducers, spreaders, distractors, blades,retractors, clamps, forceps, elevators and drills, which may bealternately sized and dimensioned, and arranged as a kit.

In some embodiments, spinal correction system 10 includes an agent,which may be disposed, packed, coated or layered within, on or about thecomponents and/or surfaces of spinal correction system 10. In someembodiments, the agent may include bone growth promoting material, suchas, for example, bone graft to enhance fixation of the components and/orsurfaces of spinal correction system 10 with vertebrae. In someembodiments, the agent may include one or a plurality of therapeuticagents and/or pharmacological agents for release, including sustainedrelease, to treat, for example, pain, inflammation and degeneration.

In one embodiment, as shown in FIGS. 22-31 , spinal correction system10, similar to the systems and methods described with regard to FIGS.1-21 , includes a spinal construct, such as, for example, a connector1412, similar to the connectors described herein.

Connector 1412 is engageable with fasteners and a surgical instrument tomanipulate tissue, similar to that described herein. Connector 1412includes a member 1416. Member 1416 includes a body, such as, forexample, a support 1418. Support 1418 includes a wall 1420 that extendsbetween an end 1422 and an end 1424. Wall 1420 extends parallel to alongitudinal axis X2 defined by a rod 1442, as described herein. Wall1420 includes a surface 1426 that defines a channel 1428. Channel 1428is configured for disposal of an actuator, as described herein.

Wall 1420 includes an extension, such as, for example, a leg 1430. Leg1430 extends from end 1422. Leg 1430 is pivotally connected with end1422 with a pin to facilitate rotation of leg 1430 relative to support1420, as described herein. Leg 1430 includes a surface 1432 that definesa portion of a support cavity 1434. Cavity 1434 is configured to captureat least a portion of a bone fastener 1650, as described herein. Surface1432 is configured to surround and/or engage a portion of a receiver ofbone fastener 1650. Surface 1432 defines a tab 1436 projecting intocavity 1434 and configured for releasably capturing bone fastener 1650.

Leg 1430 includes a surface 1438 that defines an opening 1440. Surface1438 is configured for engagement with a rod 1442, as described herein.Leg 1430 is configured for relative movement to capture MAS 1650, asdescribed herein. In some embodiments, leg 1430 is resiliently biased inan open configuration and is movable to a closed configuration tocapture bone fastener 1650, as described herein.

Wall 1420 includes an extension, such as, for example, a leg 1450. Leg1450 extends from end 1424. Leg 1450 is pivotally connected with end1424 with a pin to facilitate rotation of leg 1450 relative to support1420, as described herein. Leg 1450 includes a surface 1452 that definesa portion of support cavity 1434, as described herein. Surface 1452 isconfigured to surround and/or engage a portion of a receiver of bonefastener 1650. Surface 1452 defines a tab 1456 projecting into cavity1434 and configured for releasably capturing bone fastener 1650. Leg1450 includes a surface 1458 that defines an opening 1460. Surface 1458is configured for engagement with rod 1442, as described herein.

Leg 1450 is configured for relative movement to capture bone fastener1650, as described herein. In some embodiments, leg 1450 is resilientlybiased in an open configuration and is movable to a closed configurationto capture bone fastener 1650, as described herein.

Rod 1442 extends between an end 1470 and an end 1472. Rod 1442 isconfigured for engagement with a rod contact member, as describedherein. In some embodiments, rod 1442 includes an outer threaded surfaceengageable with leg 1430 and/or leg 1450. In some embodiments, rod 1442is configured to connect a receiver of one bone fastener with a receiverof an adjacent bone fastener, as described herein.

Member 1416 includes a part, such as, for example, a collar 1480. Collar1480 includes a surface 1482 that defines an opening 1484. Opening 1484is configured for slidable disposal of leg 1430. Collar 1480 includes asurface 1486 that defines an opening 1488. Opening 1488 is configuredfor slidable disposal of leg 1450. Collar 1480 includes an extension,such as, for example, a rod contact member 1490. Rod contact member 1490includes a surface 1492 configured to engage rod 1442. Collar 1480 isconfigured for axial translation relative to legs 1430, 1450 to movelegs 1430, 1450 into a capture configuration to capture bone fastener1650. Translation of collar 1480 causes surface 1492 to translate intoengagement with rod 1442.

Collar 1480 includes a surface 1494 that defines a channel 1496. Channel1496 is in communication with channel 1428. Channel 1496 is configuredfor disposal of actuator 1500. Actuator 1500 extends between an end 1502and an end 1504. End 1502 includes a surface 1506 configured forconnection with a surgical instrument, such as, for example, a driver.In some embodiments, surface 1506 includes a hexagonal cross-section tofacilitate engagement with a surgical tool or instrument. In someembodiments, surface 1506 may have alternative cross-sections, such as,for example, rectangular, polygonal, hexalobe, oval, or irregular.

End 1504 is fixedly connected with collar 1480 to axially translatecollar 1480 to move legs 1430, 1450 into engagement with bone fastener1650 and engage surface 1492 with rod 1442. In some embodiments,actuator 1500 includes a spring 1507 configured to bias legs 1430, 1450in an open configuration. Translation of actuator 1500 into support 1420causes a surface of support 1420 to compress spring 1507 to overcome thebias of spring 1507. Compression of spring 1507 facilitates translationof collar 1480 along legs 1430, 1450 into a capture configuration.

Support 1418 includes a surface 1508 that defines a mating element, suchas, for example, a slot 1510. Support 1418 includes a surface 1512 thatdefines a mating element, such as, for example, a slot 1514. Slots 1510,1514 are configured for mating engagement with a surgical instrument, asdescribed herein. In some embodiments, slots 1510, 1514 include acircular configuration. Slots 1510, 1514 are configured for releasableengagement with a surgical instrument to facilitate manipulation oftissue such that movement of a receiver relative to a shaft of bonefastener 1650 is resisted and/or prevented.

Connector 1412 includes a member 1516. Member 1516 includes a body, suchas, for example, a support 1518. Support 1518 includes a wall 1520 thatextends between an end 1522 and an end 1524. Wall 1520 extends parallelto axis X2, as shown in FIG. 22 . Wall 1520 includes a surface 1526 thatdefines a channel 1528. Channel 1528 is configured for disposal of anactuator, as described herein.

Wall 1520 includes an extension, such as, for example, a leg 1530. Leg1530 extends from end 1522. Leg 1530 is pivotally connected with end1522 with a pin to facilitate rotation of leg 1530 relative to support1520, as described herein. Leg 1530 includes a surface 1532 that definesa portion of a support cavity 1534. Cavity 1534 is configured to captureat least a portion of bone fastener 1650, as described herein. Surface1532 is configured to surround and/or engage a portion of a receiver ofbone fastener 1650. Surface 1532 defines a tab 1536 projecting intocavity 1534 and configured for releasably capturing bone fastener 1650.

Leg 1530 includes a surface 1538 that defines an opening 1540. Surface1538 is configured for engagement with a rod 1442, as described herein.Leg 1530 is configured for relative movement to capture bone fastener1650, as described herein. In some embodiments, leg 1530 is resilientlybiased in an open configuration and is movable to a closed configurationto capture bone fastener 1650, as described herein.

Wall 1520 includes an extension, such as, for example, a leg 1550. Leg1550 extends from end 1524. Leg 1550 is pivotally connected with end1524 with a pin to facilitate rotation of leg 1550 relative to support1520, as described herein. Leg 1550 includes a surface 1552 that definesa portion of support cavity 1534, as described herein. Surface 1552 isconfigured to surround and/or engage a portion of a receiver of bonefastener 1650. Surface 1552 defines a tab 1556 projecting into cavity1534 and configured for releasably capturing bone fastener 1650.

Leg 1550 includes a surface 1558 that defines an opening 1560. Surface1558 is configured for engagement with rod 1442, as described herein.Leg 1550 is configured for relative movement to capture bone fastener1650, as described herein. In some embodiments, leg 1550 is resilientlybiased in an open position and is movable to capture bone fastener 1650,as described herein. In some embodiments, rod 1442 includes an outerthreaded surface engageable with leg 1530 and/or leg 1550.

Member 1516 includes a part, such as, for example, a collar 1580. Collar1580 includes a surface 1582 that defines an opening 1584. Opening 1584is configured for slidable disposal of leg 1530. Collar 1580 includes asurface 1586 that defines an opening 1588. Opening 1588 is configuredfor slidable disposal of leg 1550. Rod contact member 1590 includes asurface 1592 configured to engage rod 1442.

Collar 1580 is configured for axial translation relative to legs 1530,1550 to move legs 1530, 1550 into a capture configuration to capturebone fastener 1650. Translation of collar 1580 causes surface 1592 totranslate into engagement with rod 1442.

Collar 1580 includes a surface 1594 that defines a channel 1596. Channel1596 is in communication with channel 1528. Channel 1596 is configuredfor disposal of actuator 1600. Actuator 1600 extends between an end 1602and an end 1604. End 1602 includes a surface 1606 configured forconnection with a surgical instrument, such as, for example, a driver.In some embodiments, surface 1606 includes a hexagonal cross-section tofacilitate engagement with a surgical tool or instrument. In someembodiments, surface 1606 may have alternative cross-sections, such as,for example, rectangular, polygonal, hexalobe, oval, or irregular.

End 1604 is fixedly connected with collar 1580 to axially translatecollar 1580 to move legs 1530, 1550 into engagement with bone fastener1650 and engage surface 1592 with rod 1442. In some embodiments,actuator 1600 includes a spring 1607 configured to bias legs 1530, 1550in the open configuration. Translation of actuator 1600 into support1520 causes a surface of support 1520 to compress spring 1507 toovercome the bias of spring 1507. Compression of spring 1507 facilitatestranslation of collar 1580 along legs 1530, 1550 into a captureconfiguration.

Bone fastener 1650 is configured for implantation with tissue, asdescribed herein. Bone fastener 1650 includes a receiver 1652 having apair of spaced apart arms 1654, 1654 a. Receiver 1652 is configured forengagement with connector 1412, as described herein. Arms 1654, 1654 ainclude an inner surface that defines a U-shaped passageway 1656, asshown in FIG. 23 . Passageway 1656 is configured for disposal of rod1442, as described herein.

Arm 1654 includes slot 1658 configured for mating engagement with asurgical instrument, as described herein. Arm 1654 a includes slots 1660configured for a mating engagement with a surgical instrument, asdescribed herein. In some embodiments, slots 1658, 1660 include anelongate configuration. Slots 1658, 1660 are configured for releasableengageable with a surgical instrument to facilitate manipulation oftissue such that movement of a receiver relative to a shaft of bonefastener 1650 is resisted and/or prevented. Bone fastener 1650 includesa shaft 1662 configured for penetrating tissue, as described herein.

In assembly, operation and use, spinal correction system 10, similar tothe systems and methods described herein, including connector 1412, asdescribed herein, is employed with a surgical procedure, such as, forexample, a PSO procedure for treatment of a spine of a patient includingvertebrae V, as shown in FIGS. 24-31 . Spinal correction system 10 mayalso be employed with other surgical procedures, such as, for example,discectomy, laminectomy, fusion, laminotomy, laminectomy, nerve rootretraction, foramenotomy, facetectomy, decompression, spinal nucleus ordisc replacement and bone graft and implantable prosthetics includingplates, rods, and bone engaging fasteners for securement of connector1412.

In use, to treat the affected section of vertebrae V, similar to thatdescribed herein, a medical practitioner obtains access to a surgicalsite including vertebrae V, as shown in FIG. 31 , in any appropriatemanner, such as through incision and retraction of tissues. An incisionis made in the body of a patient and a cutting instrument (not shown)creates a surgical pathway for implantation of components of spinalcorrection system 10. A preparation instrument (not shown) can beemployed to prepare tissue surfaces of vertebrae V, as well as foraspiration and irrigation of a surgical region. Bone fasteners 1650 areengaged with vertebrae V along a lateral side L of vertebrae V. In someembodiments, bone fasteners 1650 are disposed in pairs 1650 a, 1650 balongside L. In some embodiments, pair 1650 a is disposed inferior tovertebra V2 and pair 1650 b is disposed superior to vertebra V2.

Supports 1418, 1518 are connected to a surgical instrument, such as, forexample, an inserter 1700 and an inserter 1700 a, similar to inserter1700 described herein, as shown in FIGS. 24-29 . Inserter 1700 includesa member, such as, for example, a sleeve 1702. Sleeve 1702 extendsbetween an end 1704 and an end 1706 defining an axis L4. End 1704includes a surface 1708 that defines an opening 1710. Opening 1710 isconfigured for disposal of a driver 1712, as described herein. Sleeve1702 includes a surface 1714 that defines a channel 1716. Channel 1716is disposed in communication with opening 1710 to facilitate insertionand manipulation of driver 1712, as described herein. End 1706 includesa surface 1720 that defines a cavity 1722. Cavity 1722 includes walls1724 a, 1724 b, 1724 c and 1724 d that define a tubular configuration.Cavity 1722 is configured to capture and engage support 1418, asdescribed herein.

Wall 1724 b includes a surface 1726 that defines an elongate opening1728. Opening 1728 is configured for moveable disposal of an arm 1740,as described herein. Wall 1724 d includes a surface 1730 that defines anelongate opening 1732. Opening 1732 is configured for moveable disposalof an arm 1742, as described herein. Arms 1740, 1742 are configured toengage detents 1510, 1514 to capture support 1418.

Arms 1740, 1742 are configured for relative movement to capture support1418 in a quick release configuration, as described herein. Arm 1740extends between an end 1744 and an end 1746. End 1744 includes agripping surface 1748 configured to facilitate manipulation of arm 1740.End 1746 includes a capture element 1750. Capture element 1750 isconfigured to engage detent 1510. Arm 1740 is connected with sleeve 1702by a spring 1752. Spring 1752 is configured to resiliently bias arm 1740in a closed configuration, as shown in FIG. 26 .

Arm 1742 extends between an end 1760 and an end 1762. End 1760 includesa gripping surface 1764 configured to facilitate manipulation of arm1742. End 1762 includes a capture element 1766. Capture element 1766 isconfigured to engage detent 1514. Arm 1742 is connected with sleeve 1702by a spring 1768. Spring 1768 is configured to resiliently bias arm 1742in a closed configuration, as shown in FIG. 26 . In some embodiments,arms 1740, 1742 are resiliently biased in a closed configuration tocapture support 1418, as shown in FIG. 26 , and in an openconfiguration, as shown in FIG. 28 , as described herein. Movement ofarms 1740, 1742 is configured to engage support 1418 in a quick releaseconfiguration such that sleeve 1702 and support 1418 are releasablyfixable without tools, via biased arms 1740, 1742 to facilitateintra-operative connection, similar to that described herein.

Inserter 1700 includes a projection, such as, for example, an extension1790. Extension 1790 is disposed offset from axis L4, as shown in FIG.25 . In some embodiments, extension 1790 may be variously orientedrelative to axis L4, such as, for example, transverse and/or angled.Extension 1790 extends between an end 1792 and an end 1794. End 1792 isconfigured for connection with sleeve 1702. In some embodiments,extension 1790 is monolithically formed with sleeve 1702. End 1794 isconfigured for disposal with passageway 1656 of bone fasteners 1650 tofacilitate engagement therewith.

Inserters 1700, 1700 a are configured to guide supports 1418, 1518 forconnection with bone fasteners 1650. As driver 1712 translates intoengagement with actuator 1500, actuator 1500 causes translation ofcollar 1480 over legs 1430, 1450 to move legs 1430, 1450 into a closedconfiguration. In the closed configuration, legs 1430, 1450 engage slots1658 to capture bone fastener 1650. Collar 1480 is translated intoengagement with rod 1442 to fix rod 1442 with support 1418 and bonefastener 1650. Similarly, inserter 1700 a includes an extension 1790 aand is manipulated to engage support 1518 with bone fastener 1650.Supports 1418, 1518 are connected with bone fasteners 1650 to resistand/or prevent movement of receivers 1652. In some embodiments, bonefasteners 1650 include 6 degrees of freedom of movement, similar to thatdescribed herein, and supports 1418, 1518 are connected with bonefasteners 1650 to resist and/or prevent movement of receivers 1652 in 5of 6 degrees of freedom of movement such that receivers 1652 are free toroll in a medial lateral direction. Inserters 1700, 1700 a include aquick release configuration, as described herein, and are removed fromsupports 1418, 1518.

Referring to FIGS. 30 and 31 , surgical instrument 250, as describedherein, includes arm 262 connected with a linear part 1866, similar topart 266 described herein, and arm 562 connected with a linear part1966, similar to part 566 described herein. Part 1866 is connected witha sleeve 1890, similar to sleeve 1700 described herein and part 1966 isconnected with a sleeve 1890 a, similar to sleeve 1700 described herein.In some embodiments, rack 252 and part 1866 define a joint, such as, forexample a third level joint of arm 262 configured to allow part 1866 topivot relative to rack 252. A locking mechanism similar to lockingmechanism 276 may be manipulated to tighten the third level joint of arm262 to fix part 1866 relative to rack 252. The locking mechanism may bemanipulated to loosen the third level joint of arm 262 to allow part1866 to pivot relative to rack 252. In some embodiments, rack 252 andpart 1966 define a joint, such as, for example a third level joint ofarm 562 configured to allow part 1966 to pivot relative to rack 252. Alocking mechanism similar to locking mechanism 576 may be manipulated totighten the third level joint of arm 562 to fix part 1966 relative torack 252. The locking mechanism may be manipulated to loosen the thirdlevel joint of arm 562 to allow part 1966 to pivot relative to rack 252.

In some embodiments, part 1866 is pivotable relative to arm 262 about ahinge pin 1868 and part 1966 is pivotable relative to arm 562 about ahinge pin 1968. In some embodiments, hinge pin 1868 defines a joint,such as, for example a second level joint of arm 262 configured to allowpart 1866 to pivot relative to arm 262. A locking mechanism similar tolocking mechanism 276 may be manipulated to tighten the second leveljoint of arm 262 to fix part 1866 relative to arm 262, as discussedherein. The locking mechanism may be manipulated to loosen the secondlevel joint of arm 262 to allow part 1866 to pivot relative to arm 262,as discussed herein. In some embodiments, hinge pin 1968 defines ajoint, such as, for example a second level joint of arm 562 configuredto allow part 1966 to pivot relative to arm 562. A locking mechanismsimilar to locking mechanism 576 may be manipulated to tighten thesecond level joint of arm 562 to fix part 1966 relative to arm 562, asdiscussed herein. The locking mechanism may be manipulated to loosen thesecond level joint of arm 562 to allow part 1966 to pivot relative toarm 562, as discussed herein.

In some embodiments, part 1866 and sleeve 1890 define a joint, such as,for example, a first level joint 1868 of arm 262 configured to allowsleeve 1890 to pivot relative to part 1866. Tightening first level joint1868 of arm 262 causes sleeve 1890 to be fixed relative to part 1866.Loosing first level joint 1868 of arm 262 causes sleeve 1890 to pivotrelative to part 1866. In some embodiments, part 1966 and sleeve 1890 adefine a joint, such as, for example, a first level joint 1968 of arm562 configured to allow sleeve 1890 a to pivot relative to part 1966.Tightening first level joint 1968 of arm 562 causes sleeve 1890 a to befixed relative to part 1966. Loosing first level joint 1968 of arm 562causes sleeve 1890 a to pivot relative to part 1966.

Surgical instrument 250 is connected with supports 1418, 1518 disposedalong a side of vertebrae V, as shown in FIG. 31 . In some embodiments,part 1866 and/or part 1966 are rotatable relative to arm 262, arm 562,rack 252, the spinal constructs and/or vertebrae V to orient sleeve 1890and/or sleeve 1890 a in a selected orientation to capture one or moreconnectors 1412. In some embodiments, part 1866 is fixed in a selectedorientation with locking mechanism 276 and part 1966 is fixed in aselected orientation with locking mechanism 576, as described herein.Sleeves 1890, 1890 a are translated over supports 1418, 1518 and engagedwith slots 1510, 1514 in a quick release configuration, as describedherein. Slots 1510, 1514 are configured for a mating engagement with oneor a plurality of alternate surgical instruments in a quick releaseconfiguration, as described herein, to facilitate the interchangeabilityof connectors 1412 with alternate surgical instruments, as describedherein.

Lock 600 is manipulated to axially translate arm 562 along rack 252relative to arm 262 to facilitate compression and/or distraction ofvertebrae V. Translation of arm 562 relative to arm 262 along rack 252,in a direction shown by arrow P in FIG. 31 , distracts vertebrae V toopen vertebral space VS. In some embodiments, a spinal implant, such as,for example, an intrabody implant is disposed within vertebral space VS,as described herein.

Translation of arm 562, in a direction shown by arrow O in FIG. 31 , isconfigured to compress vertebrae V to achieve correction, for example, aselected lordosis. In some embodiments, surgical instrument 250manipulates vertebrae V during a surgical correction treatment torotate, displace, pull, twist or align vertebrae V to a selectedorientation for sagittal, coronal and/or axial correction. In someembodiments, surgical instrument 250 applies derotation forces tovertebrae V for correction of vertebrae V.

In some embodiments, spinal correction system 10 includes surgicalinstrument 250, a surgical instrument 250 a that is the same or similarto surgical instrument 250 and a plurality of spinal constructs ortemporary spinal rods, such as, for example, a plurality of short rods,a plurality of connectors that are the same or similar to connector 12and/or a plurality of connectors that are the same or similar toconnector 1412. As shown in FIGS. 32-36 , surgical instrument 250 aincludes a sleeve 290 b that is the same or similar to sleeve 290 and asleeve 290 c that is the same or similar to sleeve 290 a. Spinalcorrection system 10 may also be employed with other surgicalprocedures, such as, for example, discectomy, laminectomy, fusion,laminotomy, laminectomy, nerve root retraction, foraminotomy,facetectomy, decompression, spinal nucleus or disc replacement and bonegraft and implantable prosthetics including plates, rods, and boneengaging fasteners.

MAS screws 200 are engaged with vertebrae V along lateral side L ofvertebrae V, as shown in FIG. 15 . In some embodiments, MAS screws 200are disposed in pairs 200 a, 200 b alongside L. In some embodiments,pair 200 a is disposed inferior to vertebra V2 and pair 200 b isdisposed superior to vertebra V2. DRMAS 220 are engaged along acontralateral side CL of vertebrae V, as shown in FIG. 15 . In someembodiments, DRMAS screws 220 are disposed in pairs 220 a, 220 balongside CL. In some embodiments, pair 220 a is disposed inferior tovertebra V2 and pair 220 b is disposed superior to vertebra V2. Thereceivers of MAS 200 and DRMAS 220 are configured to rotate within sixdegrees relative to the shafts of MAS 200 and DRMAS 220.

Connectors, such as, for example, temporary spinal rods are engaged withpairs 200 a, 200 b, 220 a, 220 b. For example, in some embodiments,connector 12 is engaged with pair 200 a such that support 18 is disposedadjacent vertebra V2 and rod 36 extends in an inferior orientation to anadjacent MAS 200, as shown in FIG. 16 . Set screw 80 is engaged withreceiver 202 disposed adjacent vertebrae V2. A connector 12 a that isthe same or similar to connector 12 is engaged with pair 200 b such thatsupport 18 is disposed adjacent vertebra V2 and rod 36 extends in asuperior orientation to an adjacent MAS 200. Set screw 80 is engagedwith receiver 202 disposed adjacent vertebrae V2. A connector 12 b thatis the same or similar to connector 12 is engaged with pair 220 a suchthat support 18 is disposed adjacent vertebra V2 and rod 36 extends inan inferior orientation to an adjacent DRMAS 220, as shown in FIG. 16 .Set screw 80 is engaged with receiver 202 disposed adjacent vertebraeV2. A connector 12 c that is the same or similar to connector 12 isengaged with pair 220 b such that support 18 is disposed adjacentvertebra V2 and rod 36 extends in a superior orientation to an adjacentDRMAS 220. Set screw 80 is engaged with receiver 202 disposed adjacentvertebrae V2.

A surgical instrument, such as, for example, a driver is connected withset screw 80 and/or set screw 180 to facilitate engagement of supports18, 118. Support 118 is engaged with pair 200 a such that set screw 180is engaged with the adjacent MAS screw 200 receiver 202 and rod 36, asshown in FIG. 17 . Support 118 is engaged with pair 200 b such that setscrew 180 is engaged with the adjacent receiver 202 and rod 36. Support118 is engaged with pair 220 a such that set screw 180 is engaged withthe adjacent DRMAS 220 receiver 222 and rod 36. Support 118 is engagedwith pair 220 b such that set screw 180 is engaged with the adjacentDRMAS 220 receiver 222 and rod 36.

Attachment of connectors 12, 12 a, 12 b, 12 c with pairs 200 a, 200 b,220 a, 220 b resists and/or prevents movement of the receivers of MAS200 and DRMAS 220 relative to the shafts of MAS 200 and DRMAS 220 and/orvertebrae attached therewith. In some embodiments, movement of thereceivers of MAS 200 and DRMAS 220 relative to the shafts of MAS 200 andDRMAS 220 and/or vertebrae can be prevented in one or a plurality ofdegrees of freedom of the fasteners, as described herein.

Surgical instrument 250 is connected with supports 118 disposedalongside CL of vertebrae V and surgical instrument 250 a is connectedwith supports 118 disposed alongside L of vertebrae V, as shown in FIG.32 . In particular, sleeve 290 is connected with support 118 that isconnected with pair 220 a alongside CL; sleeve 290 a is connected withsupport 118 that is connected with pair 220 b alongside CL; sleeve 290 bis connected with support 118 that is connected with pair 200 aalongside L; and sleeve 290C is connected with support 118 that isconnected with pair 200 b alongside L. In some embodiments, connectors1412 are attached with pairs 200 a, 200 b, 220 a, 220 b in place ofconnectors 12, 12 a, 12 b, 12 c and surgical instruments 250, 250 a areconnected with connectors 1412, as discussed herein.

In some embodiments, one or more of the joints of arms 262, 562 ofsurgical instrument 250 and/or one or more of the joints of arms 262,562 of surgical instrument 250 a are loosened prior to connectingsurgical instrument 250 and/or surgical instrument 250 a with connectors12, 12 a, 12 b and/or 12 c. For example, in some embodiments, the firstlevel joint of arm 262 of surgical instrument 250 is loosened to allowsleeve 290 to pivot relative to part 266 prior to connecting surgicalinstrument 250 with connector 12 b. In some embodiments, the first leveljoint of arm 562 of surgical instrument 250 is loosened to allow sleeve290 a to pivot relative to part 566 prior to connecting surgicalinstrument 250 with connector 12 c.

In some embodiments, the second level joint of arm 262 of surgicalinstrument 250 is loosened to allow part 264 to pivot relative to part266 of surgical instrument 250 prior to connecting surgical instrument250 with connector 12 b. In some embodiments, the second level joint ofarm 562 of surgical instrument 250 is loosened to allow part 564 topivot relative to part 566 of surgical instrument 250 prior toconnecting surgical instrument 250 with connector 12 c.

In some embodiments, the third level joint of arm 262 of surgicalinstrument 250 is loosened to allow part 264 to pivot relative to rack252 of surgical instrument 250 prior to connecting surgical instrument250 with connector 12 b. In some embodiments, the third level joint ofarm 562 of surgical instrument 250 is loosened to allow part 564 topivot relative to rack 252 of surgical instrument 250 prior toconnecting surgical instrument 250 with connector 12 c.

In some embodiments, the first level joint of arm 262 of surgicalinstrument 250 a is loosened to allow sleeve 290 b to pivot relative topart 266 prior to connecting surgical instrument 250 a with connector12. In some embodiments, the first level joint of arm 562 of surgicalinstrument 250 a is loosened to allow sleeve 290 c to pivot relative topart 566 prior to connecting surgical instrument 250 a with connector 12a.

In some embodiments, the second level joint of arm 262 of surgicalinstrument 250 a is loosened to allow part 264 to pivot relative to part266 of surgical instrument 250 a prior to connecting surgical instrument250 with connector 12. In some embodiments, the second level joint ofarm 562 of surgical instrument 250 a is loosened to allow part 564 topivot relative to part 566 of surgical instrument 250 a prior toconnecting surgical instrument 250 with connector 12 a.

In some embodiments, the third level joint of arm 262 of surgicalinstrument 250 a is loosened to allow part 264 to pivot relative to rack252 of surgical instrument 250 a prior to connecting surgical instrument250 a with connector 12. In some embodiments, the third level joint ofarm 562 of surgical instrument 250 is loosened to allow part 564 topivot relative to rack 252 of surgical instrument 250 a prior toconnecting surgical instrument 250 a with connector 12 a.

In some embodiments, one or more of the joints of arms 262, 562 ofsurgical instrument 250 and/or one or more of the joints of arms 262,562 of surgical instrument 250 a are tightened after connecting surgicalinstrument 250 and/or surgical instrument 250 a with connectors 12, 12a, 12 b and/or 12 c. For example, in some embodiments, the first leveljoint of arm 262 of surgical instrument 250 is tightened to fix sleeve290 relative to part 266 after connecting surgical instrument 250 withconnector 12 b. In some embodiments, the first level joint of arm 562 ofsurgical instrument 250 is tightened to fix sleeve 290 a to part 566after connecting surgical instrument 250 with connector 12 c. In someembodiments, the first level joint of arm 262 and/or arm 562 of surgicalinstrument 250 is/are tightened while ensuring that vertebrae V arepositioned as desired.

In some embodiments, the second level joint of arm 262 of surgicalinstrument 250 is tightened to fix part 264 relative to part 266 ofsurgical instrument 250 after connecting surgical instrument 250 withconnector 12 b. In some embodiments, the second level joint of arm 562of surgical instrument 250 is tightened to fix part 564 to pivotrelative to part 566 of surgical instrument 250 after connectingsurgical instrument 250 with connector 12 c. In some embodiments, thesecond level joint of arm 262 and/or arm 562 of surgical instrument 250is/are tightened while ensuring that vertebrae V are positioned asdesired.

In some embodiments, the third level joint of arm 262 of surgicalinstrument 250 is tightened to fix part 264 relative to rack 252 ofsurgical instrument 250 after connecting surgical instrument 250 withconnector 12 b. In some embodiments, the third level joint of arm 562 ofsurgical instrument 250 is tightened to fix part 564 relative to rack252 of surgical instrument 250 after connecting surgical instrument 250with connector 12 c. In some embodiments, the third level joint of arm262 and/or arm 562 of surgical instrument 250 is/are tightened whileensuring that vertebrae V are positioned as desired. In someembodiments, at least one of the joints of arm 262 of surgicalinstrument 250 and/or at least one of the joints of arm 262 of surgicalinstrument 250 is/are tightened before surgical instrument 250 a isattached to connectors 12, 12 a.

In some embodiments, the first level joint of arm 262 of surgicalinstrument 250 a is tightened to fix sleeve 290 b relative to part 266after connecting surgical instrument 250 a with connector 12. In someembodiments, the first level joint of arm 562 of surgical instrument 250a is tightened to fix sleeve 290 c relative to part 566 after connectingsurgical instrument 250 a with connector 12 a. In some embodiments, thefirst level joint of arm 262 and/or arm 562 of surgical instrument 250 ais/are tightened while ensuring that vertebrae V are positioned asdesired. In some embodiments, the first level joints of arms 262, 562 ofsurgical instrument 250 and the first level joints of arms 262, 562 ofsurgical instrument 250 a are tightened before the second level jointsof arms 262, 562 of surgical instrument 250 are tightened.

In some embodiments, the second level joint of arm 262 of surgicalinstrument 250 a is tightened to fix 264 to pivot relative to part 266of surgical instrument 250 a after connecting surgical instrument 250with connector 12. In some embodiments, the second level joint of arm562 of surgical instrument 250 a is tightened to fix part 564 relativeto part 566 of surgical instrument 250 a after connecting surgicalinstrument 250 with connector 12 a. In some embodiments, the secondlevel joint of arm 262 and/or arm 562 of surgical instrument 250 ais/are tightened while ensuring that vertebrae V are positioned asdesired.

In some embodiments, the third level joint of arm 262 of surgicalinstrument 250 a is tightened to fix part 264 relative to rack 252 ofsurgical instrument 250 a after connecting surgical instrument 250 awith connector 12. In some embodiments, the third level joint of arm 562of surgical instrument 250 is tightened to fix part 564 relative to rack252 of surgical instrument 250 a after connecting surgical instrument250 a with connector 12 a. In some embodiments, the third level joint ofarm 262 and/or arm 562 of surgical instrument 250 a is/are tightenedwhile ensuring that vertebrae V are positioned as desired. In someembodiments, the first level joints of arms 262, 562 of surgicalinstrument 250 and at least one of the joints of arms 262, 562 ofsurgical instrument 250 a are tightened the second level joints of arms262, 562 of surgical instrument 250 are tightened.

In some embodiments, a rack lock, such as, for example, lock 600 ofsurgical instrument 250 and/or lock 600 of surgical instrument 250 ais/are tightened after one or more of the joints of arms 262, 562 ofsurgical instrument 250 and/or one or more of the joints of arms 262,562 of surgical instrument 250 a are tightened to fix arm 264 ofsurgical instrument 250 relative to arm 564 of surgical instrument 250and/or to fix arm 264 of surgical instrument 250 a relative to arm 564of surgical instrument 250 a. In some embodiments, the rack lock ofsurgical instrument 250 and/or the rack lock of surgical instrument 250a is/are tightened while ensuring that vertebrae V are positioned asdesired.

In some embodiments, a surgical instrument, such as, for example, anosteotome is utilized to facilitate removing all or a portion ofvertebra V2 and adjacent intervertebral disc tissue to define avertebral space VS after the rack lock of surgical instrument 250 and/orthe rack lock of surgical instrument 250 a is/are tightened, as shown inFIG. 33 . In some embodiments, vertebral space VS can include posteriorportions of the spine, such as, for example, pedicles, laminae and/orspinous process. In some embodiments, a wedge portion of bone and/orother tissue is removed from a selected vertebra and adjacentintervertebral disc tissue remains intact.

In some embodiments, vertebrae V are selectively distracted after theosteotome creates vertebral space VS to better accommodate a spinalimplant, such as, for example, implant 700. In some embodiments,vertebrae V are selectively distracted by loosening and/or unlocking therack lock of surgical instrument 250 and/or the rack lock of surgicalinstrument 250 a to allow arm 562 of surgical instrument 250 totranslate relative to arm 262 along rack 252 of surgical instrument 250and/or to allow arm 562 of surgical instrument 250 a to translaterelative to arm 262 along rack 252 of surgical instrument 250 a. As arm562 of surgical instrument 250 translates relative to arm 262 along rack252 of surgical instrument 250 and/or arm 562 of surgical instrument 250a translates relative to arm 262 along rack 252 of surgical instrument250 a, vertebra V1 pivots relative to vertebra V2 about the fulcrumprovided by implant 700. Implant 700 is then disposed within vertebralspace VS, as shown in FIG. 34 . In some embodiments, implant 700 isconfigured to preserve anterior height and maintain alignment ofvertebrae V. In some embodiments, the rack lock of surgical instrument250 and/or the rack lock of surgical instrument 250 a is/are tightenedafter implant 700 is disposed within vertebral space VS. In someembodiments, selectively distracting vertebrae V comprises distractingvertebrae V with one of surgical instruments 250, 250 a and compressingvertebrae with the other one of surgical instruments 250, 250 a.

In some embodiments, vertebrae V are selectively compressed afterimplant 700 is disposed within vertebral space VS. Vertebrae V areselectively compressed by loosening and/or unlocking the rack lock ofsurgical instrument 250 and/or the rack lock of surgical instrument 250a to allow arm 562 of surgical instrument 250 to translate relative toarm 262 along rack 252 of surgical instrument 250 and/or to allow arm562 of surgical instrument 250 a to translate relative to arm 262 alongrack 252 of surgical instrument 250 a. As arm 562 of surgical instrument250 translates relative to arm 262 along rack 252 of surgical instrument250 and/or arm 562 of surgical instrument 250 a translates relative toarm 262 along rack 252 of surgical instrument 250 a, vertebrae Vcompress to achieve correction, for example, a selected lordosis, asshown in FIG. 34 . Vertebrae V are compressed to assist and/or causevertebrae V to locate at a desired post-operation position, which mayinclude assisting and/or causing vertebrae V to capture or more robustlyengage implant 700. In some embodiments, capturing or more robustlyengaging implant 700 comprises positioning vertebrae V at preferredangles relative to one another. In some embodiments, surgical instrument250 and/or surgical instrument 250 a manipulate(s) vertebrae V during asurgical correction treatment to rotate, displace, pull, twist or alignvertebrae V to a selected orientation for sagittal, coronal and/or axialcorrection. In some embodiments, surgical instrument 250 and/or surgicalinstrument 250 a apply derotation forces to vertebrae V for correctionof vertebrae V. In some embodiments, the rack lock of surgicalinstrument 250 and/or the rack lock of surgical instrument 250 a is/areloosened and/or unlocked after implant 700 is disposed within vertebralspace VS and prior to compressing vertebrae V. In some embodiments, therack lock of surgical instrument 250 and/or the rack lock of surgicalinstrument 250 a is/are tightened and/or locked after vertebrae V arecompressed. In some embodiments, selectively compressing vertebrae Vcomprises distracting vertebrae V with one of surgical instruments 250,250 a and compressing vertebrae with the other one of surgicalinstruments 250, 250 a.

Surgical instrument 250, surgical instrument 250 a and spinal connectors12, 12 a, 12 b, 12 c are removed after vertebrae V are compressed toachieve selected lordosis, as shown in FIG. 35 . After surgicalinstruments 250, 250 a and connectors 12, 12 a, 12 b, 12 c are removed,pair 200 a is not connected to pair 200 b and pair 220 a is notconnected to pair 220 b, as shown in FIG. 35 . Furthermore, screws 200of pair 200 a are not connected to one another, screws 200 of pair 200 bare not connected to one another, screws 220 of pair 220 a are notconnected to one another and screws 220 of pair 220 b are not connectedto one another, as shown in FIG. 35 . A spinal rod 702 is positionedwithin implant cavities of the receivers of pairs 200 a, 200 b and aspinal rod 704 is positioned within implant cavities of the receivers ofpairs 220 a, 220 b to maintain selected lordosis, as shown in FIG. 36 .In some embodiments, the rack lock of surgical instrument 250 and/or therack lock of surgical instrument 250 a is/are loosened and/or unlockedafter implant 700 is disposed within vertebral space VS and beforevertebrae V are compressed. In some embodiments, the rack lock ofsurgical instrument 250 and/or the rack lock of surgical instrument 250a is/are tightened and/or locked after vertebrae V are compressed andbefore spinal rods 702, 704 are connected with pairs 200 a, 200 b, 220a, 220 b. In some embodiments, set screws are connected with each ofscrews 200, 220 such that the set screws directly engage spinal rod 702or spinal rod 704 to maintain selected lordosis. That is, outer threadsof the set screws are threaded with inner thread of receivers of screws200, 220 to translate the set screws relative to screws 200, 220 suchthat the set screws directly engage spinal rod 702 or spinal rod 704 tomaintain selected lordosis.

In some embodiments, spinal rods 702, 704 may be connected with screws200, 220 without using connectors, such as, for example, connector 12 orconnector 1412. For example, in some embodiments, sleeves 290, 290 a,290 b, 290 c directly engage pairs 200 a, 200 b, 220 a, 220 b, as shownin FIG. 37 . In particular, sleeve 290 directly engages one of pair 220a, sleeve 290 a directly engages one of pair 220 b, sleeve 290 bdirectly engages one of pair 200 a and sleeve 290 c directly engages oneof pair 200 b. At least one of the joints of surgical instrument 250and/or surgical instrument 250 a are tightened, as discussed herein. Insome embodiments, surgical instrument 250 and/or surgical instrument 250a are used to distract vertebrae V and a wedge portion of bone and/orother tissue is removed from a selected vertebra using an osteotome. Insome embodiments, surgical instrument 250 and/or surgical instrument 250a are used to distract vertebrae V after vertebral space VS is formed tobetter accommodate a spinal implant, such as, for example, implant 700.Implant 700 is then positioned in vertebral space VS. After implant 700is positioned in vertebral space VS, surgical instrument 250 and/orsurgical instrument 250 a is/are used to compress vertebrae V, as shownin FIG. 38 . Surgical instrument 250 and surgical instrument 250 a areremoved. Spinal rod 702 is positioned within implant cavities of thereceivers of pairs 200 a, 200 b and spinal rod 704 is positioned withinimplant cavities of the receivers of pairs 220 a, 220 b to maintainselected lordosis. Set screws are connected with each of screws 200, 220such that the set screws directly engage spinal rod 702 or spinal rod704 to maintain selected lordosis.

It will be understood that various modifications may be made to theembodiments disclosed herein. Therefore, the above description shouldnot be construed as limiting, but merely as exemplification of thevarious embodiments. Those skilled in the art will envision othermodifications within the scope and spirit of the claims appended hereto.

What is claimed is:
 1. A kit for treating a spine, the kit comprising: afirst controller; a second controller, the controllers each including: alongitudinal element, a first arm connected with the longitudinalelement and including a body engageable with a first spinal construct,the body being rotatable relative to the first arm in a firstorientation and a second orientation, the body including a lock to fixthe body relative to the first arm, and a second arm being axiallytranslatable relative to the first arm and including a body engageablewith a second spinal construct, the body of the second arm beingrotatable relative to the second arm in a first orientation and a secondorientation, the body of the second arm including a lock to fix the bodyof the second arm relative to the second arm; and a plurality of bonefasteners, wherein the lock of the first arm includes a collar and ascrew, the first arm extending through the collar, the screw extendingthrough the body of the first arm and into the collar.
 2. A kit asrecited in claim 1, further comprising: a plurality of temporaryimplants; and a plurality of permanent implants.
 3. A kit as recited inclaim 2, wherein the temporary implants are first spinal rods and thepermanent implants are second spinal rods, the second spinal rods beingdifferent than the first spinal rods.
 4. A kit as recited in claim 1,wherein the bodies each define a cavity, at least one of the bonefasteners including a head defining an implant cavity, the head beingconfigured for disposal in one of the cavities.
 5. A kit as recited inclaim 1, wherein the bodies each define a cavity, at least one of thebone fasteners including a head comprising spaced apart arms, the armsdefining an implant cavity therebetween, the arms being configured fordisposal in one of the cavities.
 6. A kit as recited in claim 1, whereinat least one of the bone fasteners includes a shaft and a receivercoupled to the shaft such that the receiver is rotatable relative to theshaft in a plurality of planes, the receiver comprising spaced apartfirst and second arms, the arms defining an implant cavity therebetween,the implant cavity being configured for disposal of a rod.
 7. A kit asrecited in claim 1, wherein at least one of the bone fasteners includesa shaft and a receiver coupled to the shaft such that the receiver isrotatable relative to the shaft in a plurality of planes, the receivercomprising first and second arms and a third arm between the first andsecond arms, the first and third arms defining a first implant cavitytherebetween configured for disposal of a first rod, the second andthird arms defining a second implant cavity therebetween configured fordisposal of a second rod.
 8. A kit as recited in claim 1, wherein:rotation of the screw relative to the body of the first arm translatesthe collar relative to the first arm to move the body of the first armbetween a first configuration in which the body of the first arm isrotatable relative to the first arm and a second configuration in whichthe body of the first arm is fixed relative to the first arm.
 9. A kitas recited in claim 8, wherein rotation of the screw relative to thebody of the first arm in a first direction moves the body of the firstarm from the first configuration to the second configuration androtation of the screw relative to the body of the first arm in anopposite second direction moves the body of the first arm from thesecond configuration to the first configuration.
 10. A kit as recited inclaim 8, wherein the screw is spaced apart from the first arm when thebody of the first arm is in the first configuration and the screwdirectly engages the first arm when the body of the first arm is in thesecond configuration.
 11. A kit as recited in claim 8, wherein the screwhas a hexagonal head that extends through a hexagonal opening in thebody of the first arm.
 12. A kit as recited in claim 8, wherein thefirst arm extends through a first opening of the collar and the screwextends through a second opening of the collar, the second openingextending perpendicular to the first opening.
 13. A kit as recited inclaim 1, wherein the second arm of the first controller includes ahousing, the first controller comprising a locking element pivotablyconnected to the housing and configured to move between a firstconfiguration in which the second arm of the first controller istranslatable along the longitudinal element of the first controller anda second configuration in which the second arm of the first controlleris prevented from translating along the longitudinal element of thefirst controller.
 14. A kit as recited in claim 1, wherein the screw isconfigured to directly engage the first arm.
 15. A kit comprising: acontroller including a longitudinal element, a first arm connected withthe longitudinal element, a second arm rotatably coupled to the firstarm and a body coupled to the second arm such that the body is rotatablerelative to the second arm, the body defining a cavity, the controllercomprising a lock including a collar and a screw, the second armextending through the collar, the screw extending through the body andinto the collar; and a bone fastener configured for disposal in thecavity, wherein rotation of the screw relative to the body translatesthe collar relative to the body to move the body between a firstconfiguration in which the body is rotatable relative to the second armand a second configuration in which the body is fixed relative to thesecond arm.
 16. A kit as recited in claim 15, wherein rotation of thescrew relative to the body in a first direction moves the body from thefirst configuration to the second configuration and rotation of thescrew relative to the body in an opposite second direction moves thebody from the second configuration to the first configuration.
 17. A kitas recited in claim 15, wherein the screw is spaced apart from thesecond arm when the body is in the first configuration and the screwdirectly engages the second arm when the body is in the secondconfiguration.
 18. A kit as recited in claim 15, wherein the screw has ahexagonal head that extends through a hexagonal opening in the body. 19.A kit as recited in claim 15, wherein the second arm extends through afirst opening of the collar and the screw extends through a secondopening of the collar, the second opening extending perpendicular to thefirst opening.
 20. A kit comprising: a controller including alongitudinal element, a first arm connected with the longitudinalelement, a second arm rotatably coupled to the first arm and a bodycoupled to the second arm such that the body is rotatable relative tothe second arm, the body defining a cavity, the controller comprising alock including a collar and a screw, the second arm extending throughthe collar, the screw extending through the body and into the collar;and a bone fastener configured for disposal in the cavity, whereinrotation of the screw relative to the body translates the collarrelative to the body to move the body between a first configuration inwhich the body is rotatable relative to the second arm and a secondconfiguration in which the body is fixed relative to the second arm,wherein the screw is spaced apart from the second arm when the body isin the first configuration and the screw directly engages the second armwhen the body is in the second configuration, wherein the second armextends through a first opening of the collar and the screw extendsthrough a second opening of the collar, the second opening extendingperpendicular to the first opening, and wherein the controller includesa third arm having a housing, the controller comprising a lockingelement pivotably connected to the housing and configured to movebetween a first orientation in which the third arm is translatable alongthe longitudinal element and a second orientation in which the third armis prevented from translating along the longitudinal element.